Credentialing Specialist

Credentialing Specialist Therapy and Beyond - 3.1 Flower Mound, TX Job Details Full-time 13 hours ago Qualifications High school diploma or GED Full Job Description Company Description Therapy & Beyond is one of the largest BCBA-owned ABA organizations, founded and led by Dr. Regina Crone, BCBA-D, since 2006. At Therapy & Beyond we approach the needs of each patient both individually and as part of a dynamic interdisciplinary team working with experts in applied behavior analysis (ABA) therapy, speech-language pathology, occupational therapy, and counseling. We love helping individuals reach their full potential by supporting not only the patient but also their family. We are passionate about what we do while remaining true to our defining core values of: Putting People First, Doing Our Best Together, Making Therapy Fun, and Above All, We grow potential Job Description We are seeking a detail-oriented Credentialing Specialist to serve as a vital component of our home office team. This role will be responsible for obtaining, verifying, and maintaining the credentials, licensure, and insurance coverage for our clinical staff in Texas and Oklahoma. By ensuring accurate and timely credentialing, you will directly support the revenue cycle, minimize billing disruptions, and ensure our providers are able to serve their communities.

Key Responsibilities Database Management:

Create and maintain comprehensive digital records of provider licensing, credentials, and malpractice insurance. Manage provider profiles in industry databases (e.g., CAQH, PECOS, NPPES) with high accuracy.

Proactive Compliance:

Monitor expiration dates for licenses, DEA certificates, board certifications, and insurance policies. Issue "renew by" notifications to staff and management well in advance to prevent coverage lapses.

Verification Liaison:

Act as the primary point of contact for external agencies, hospitals, and commercial payers requesting verification of provider information.

Regulatory Research:

Stay current on updated state, federal, and payer-specific regulations (including NCQA and CMS standards) to ensure organizational policies remain compliant.

Process Optimization:

Assist in developing and revising internal credentialing Standard Operating Procedures (SOPs) to improve workflow efficiency and data integrity.

Audit Readiness:

Ensure the facility and all staff members maintain continuous compliance to ensure readiness for internal or external audits at any time.

Qualifications Required:

High School Diploma or GED. Bachelor's degree or college coursework in Health Administration, Business, or a related field.

Preferred:

Minimum of 2 years of experience in medical billing, credentialing, provider enrollment, or medical office administration. Proficiency with provider enrollment platforms (Medicare, Medicaid, Commercial Payers). Strong knowledge of medical credentialing policies, healthcare regulations, and accreditation standards. Exceptional accuracy in data entry and document verification.

Communicator:

Strong verbal and written communication skills, with the ability to speak professionally with clinicians and insurance representatives.

Organizer:

Ability to meet strict deadlines and prioritize tasks in a fast-paced environment without compromising quality.

Team Player:

Willingness to collaborate with the billing and authorization teams while possessing the self-discipline to work independently. Additional Information All your information will be kept confidential according to EEO guidelines.