Job Description

We're hiring a Credentialing Specialist to manage end-to-end credentialing and payer enrollment for behavioral and mental health providers, including individual clinicians and hospital clients. You'll ensure every provider and entity is properly enrolled, contracted, and authorized to bill commercial payers, Medicare, and Medicaid, protecting the organization from revenue leakage caused by lapsed credentials or compliance gaps.

Key Responsibilities

• Manage CAQH ProView profiles for all providers and ensure attestation every 120 days
• Verify and maintain state professional licenses (MD, PhD, LCSW, LMFT, LPC, NPs), including multi-state telehealth licensure
• Handle Group NPI (Type 2) and Individual NPI (Type 1) registrations and ensure correct linkage in NPPES
• Process commercial payer enrollments with Aetna, BCBS, UHC, Cigna, and others (90–120 day cycles)
• Manage Medicare/Medicaid enrollments via CMS-855B / 855I forms (180+ day cycles)
• Maintain CMS Certification Numbers (CCN) and audit NPI taxonomy codes for billing accuracy
• Track DEA/CDS certificates for prescribing providers
• Maintain Certificates of Liability Insurance (minimum $1M/$3M), W-9s, EIN documentation, and EFT setups
• Coordinate hospital privileges, JCAHO/CARF accreditation, and Crisis Coverage Plans
• Build and maintain a payer-specific credentialing matrix with re-credentialing reminders (every 2–3 years)
• Track effective dates against contract dates to prevent premature billing and recoupment risk
• Maintain accurate facility records for No Surprises Act and payer directory compliance

Required Qualifications

• Bachelor's degree in Healthcare Administration, Business, or related field (or equivalent experience)
• 2–4 years of provider credentialing experience, preferably in behavioral health or hospital settings
• Working knowledge of CAQH ProView, NPPES, PECOS, and major commercial payer portals
• Hands-on experience with CMS-855B / 855I Medicare and Medicaid enrollment
• Strong understanding of NPI taxonomy codes and payer re-credentialing cycles
• Familiarity with JCAHO / CARF accreditation requirements
• Excellent attention to detail and organizational skills
• Ability to manage multiple concurrent applications across diverse payers without missed deadlines

Preferred Qualifications

• CPCS or CPMSM certification through NAMSS
• Experience credentialing hospital-based behavioral health programs (IOP, PHP, inpatient psychiatry)
• Familiarity with hospital medical staff bylaws and MEC approval processes
• Knowledge of multi-state telehealth licensure for behavioral health providers