Credentialing & Contracting Specialist (ABA Services)

Department: Billing & Authorizations

Reports To: RCM Manager

Job Summary

The Credentialing & Contracting Specialist is responsible for managing the credentialing, enrollment, and payer contracting processes for ABA providers, including BCBAs, BCaBAs, RBTs, and other clinical staff. This role ensures compliance with payer, state, and regulatory requirements while supporting timely provider onboarding, recredentialing, and reimbursement readiness. The specialist acts as a liaison between providers, payers, and internal teams to support uninterrupted service delivery.

Credentialing & Provider Enrollment

Manage initial and re-credentialing for ABA providers (BCBAs, BCaBAs, RBTs, etc.)

Complete and submit provider enrollment applications with Medicaid, Tricare, and commercial payers

Maintain up-to-date provider files, including licensure, BACB certifications, background checks, and supervision documentation

Track expiration dates for credentials, licenses, and certifications and proactively initiate renewals

Ensure CAQH profiles are accurate, complete, and attested as required

Monitor payer portals for application status and follow up to resolve delays

Respond to payer audits, revalidation requests, and documentation inquiries

Contracting

Assist with payer contracting and amendments for ABA services

Maintain records of executed contracts, rate sheets, and fee schedules

Track effective dates, terminations, and renewals of payer agreements

Support leadership with administrative components of payer negotiations

Ensure providers are correctly loaded under contracts

Communication & Coordination

Serve as primary point of contact for clinicians regarding credentialing and enrollment status

Coordinate with HR, clinical leadership, billing, and operations teams to ensure accurate provider setup

Communicate with payers to resolve enrollment, network participation, and claims-related issues

Provide regular status updates to leadership

Qualifications Required

High school diploma or equivalent (Bachelor's degree preferred)

2+ years of experience in healthcare credentialing, enrollment, or contracting

Experience with Medicaid and commercial payer enrollment

Familiarity with CAQH, NPPES, and payer portals

Strong organizational skills and attention to detail

Ability to manage multiple deadlines in a fast-paced environment

Excellent written and verbal communication skills

Skills & Competencies

Highly detail-oriented and process-driven

Strong follow-through and accountability

Ability to work independently

Problem-solving and persistence with payer follow-ups

Professional handling of confidential information

Strong time management

Work Environment

Remote

Frequent interaction with clinicians, payers, and internal departments