Credentialing Specialist

Credentialing & Provider Enrollment Specialist

Behavioral Health Hospital Billing

We are hiring a Credentialing & Provider Enrollment Specialist to manage provider credentialing, payer enrollment, and compliance processes for behavioral and mental health providers, including hospital based programs and individual clinicians. The ideal candidate should have strong experience handling commercial and government payer enrollments while ensuring providers remain fully credentialed and billing ready.

Key Responsibilities

• Manage provider credentialing and payer enrollment with commercial payers, Medicare, and Medicaid

• Maintain and update CAQH profiles with timely attestations

• Process CMS 855B / 855I enrollments and PECOS updates

• Handle Group NPI (Type 2) and Individual NPI (Type 1) setup and NPPES linkage

• Verify provider licenses, DEA/CDS certificates, malpractice insurance, and credential documents

• Coordinate hospital privileges, accreditation documents, and behavioral health compliance requirements

• Track recredentialing timelines, payer effective dates, and enrollment status

• Maintain credentialing trackers, payer matrices, and follow-up reports

• Perform payer follow-ups and resolve enrollment discrepancies or application rejections

• Support multi-state telehealth provider credentialing when required


Required Qualifications

1. 2+ years of credentialing or provider enrollment experience

2. Strong knowledge of CAQH, NPPES, PECOS, and payer portals

3. Experience with commercial payer and CMS enrollments

4. Understanding of behavioral health or hospital credentialing workflows

5. Strong attention to detail, organization, and deadline management

6. Ability to manage multiple enrollments and follow-ups simultaneously


Preferred Qualifications

• Experience in Behavioral Health, IOP, PHP, or inpatient psychiatry credentialing
  
  
  

• Familiarity with JCAHO/CARF standards and hospital medical staff processes
  
  
  

• CPCS or CPMSM certification is a plus
  
  
  
  

This role is ideal for someone who understands the operational impact of credentialing accuracy and can help maintain compliant, revenue ready provider enrollment operations.