Carolinacenterforaba10d ago

Credentialing Specialist

United States·RaleighRemoteFull-Timemid

OtherCredentialing Specialist

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Quick Summary

Overview

About Kind Behavioral Health: Kind Behavioral Health is a leading provider of Applied Behavior Analysis services in North Carolina and Georgia,

Technical Tools

OtherCredentialing Specialist

About Kind Behavioral Health:

Kind Behavioral Health is a leading provider of Applied Behavior Analysis services in North Carolina and Georgia, dedicated to improving the lives of children with autism spectrum disorder (“ASD”). We provide life-changing treatment to children with ASD, providing outstanding quality care, and delivering exceptional clinical outcomes, in an environment in which all are encouraged to THINK BIG, HAVE FUN, DO GOOD, and BE KIND. We deliver treatment through individualized care plans, and target socially significant behaviors, enabling the clients we serve to lead more independent, fulfilling lives.

About the Role:

We’re looking for a Credentialing Specialist whose work will be impactful to ensuring timely access to care for families, and quick entry into providing ABA services for clinicians. This role owns end-to-end credentialing and re-credentialing for all KBH BCBAs and RBTs across all contracted payors, and is accountable for the workflows, tools, and relationships that make credentialing work reliably at scale. You’ll partner closely with HR, Training, Clinical Leadership, Scheduling, and Billing to ensure credentialing never becomes a barrier to care—and you’ll bring the data and process discipline to help ensure that is the case. You’ll be proactive and a strong advocate with payors—following up, escalating when needed, and building relationships with credentialing contacts to ensure we’re always following best practices and driving accountability with all stakeholders.

Credentialing Execution:

Manage end-to-end credentialing and re-credentialing for BCBAs and RBTs across all contracted payors—initial enrollment, recredentialing, ongoing updates, and active status maintenance.

Own the full submission lifecycle for each application: compiling all documentation, portal submission, follow-up, and resolution, with a complete and auditable paper trail.

Ensure clinician credentials and supporting documentation (BACB certification, BLS, Safety Care, NPI, CAQH, diplomas, state licenses as applicable) are current, verified, and stored to support audit readiness at any time.

Coordinate with HR, Training, Clinical, and Scheduling to ensure credential status never blocks a clinician’s start date without advance warning.

Help clinicians navigate the credentialing process, providing them with the resources and supports needed to smoothly navigate this process.

Oversee the BACB RBT Requirements Coordinator process, working closely with the clinicians managing RBT supervision KBH-wide, including BACB portal maintenance, and timely responses to BACB supervision audits.

Payor Relationships & Escalation

Serve as KBH’s primary contact with payor credentialing departments, building relationships with payors, maintaining a proactive follow-up cadence, and escalating directly when timelines are at risk.

Build and maintain a payor credentialing matrix documenting all payor-specific portal requirements, submission formats, re-credentialing cadence, common rejection reasons, key contacts, and escalation paths.

Track payor-specific patterns, such as credentialing timelines, rejection reasons, documentation requirements, etc. and use those patterns to drive process changes.

Data, Tracking & Reporting

Maintain a live credentialing tracking system that provides real-time visibility into every active application: current status, outstanding items, payor, and estimated credentialing date.

Use data to surface root causes of delays and denials, prioritize process changes by impact, and demonstrate improvement over time.

Define and track key credentialing KPIs (e.g., cycle time, aging by payor, touchpoints per application, and first-pass approval rate) and provide regular reporting to support staffing and revenue forecasting. 

Process Improvement & Systems

Document current-state workflows and handoffs across HR, Training, Clinical, Scheduling, and Billing; identify gaps, redundancies, and bottlenecks.

Build and maintain standardized credentialing tools: checklists, templates, submission packets, naming conventions, and SOPs that reduce rework and make the process transferable.

Drive continuous improvement in first-pass approval rates and time-to-credential. If something is slowing things down, own the fix.

Experience:

Prior credentialing or provider enrollment experience in a healthcare setting (required); ABA provider credentialing experience with experience credentialing both BCBAs and RBTs strongly preferred.

Hands-on experience with CAQH, NPI, and commercial + government payor portals; demonstrated best practices for maintaining audit-ready provider files.

Proven ability to build or improve credentialing processes—SOPs, tracking tools, checklists—not just maintain what was handed to you.

Comfort analyzing credentialing data to surface patterns: which payors run slow, which rejection reasons recur, and where cycle times are longest and why.

Familiarity with Medicaid MCOs and/or TRICARE is a plus given our payor mix in NC and GA.

CentralReach experience preferred; not required.

Bachelor’s degree or equivalent professional experience.