Credentialing Specialist

The Credentialing Specialist is responsible for managing all aspects of payer and provider credentialing for Applied Behavior Analysis (ABA) and any other behavioral health services. This role ensures providers and locations are properly credentialed and enrolled with commercial and government payers, maintaining compliance with regulatory and contractual requirements to support uninterrupted billing and reimbursement.

Essential Duties and Responsibilities: 

• Coordinate and manage initial credentialing and recredentialing for ABA and other BH providers (e.g., BCBAs, RBTs).
• Complete and submit provider enrollment applications with commercial insurance, Medicaid, and other payers.
• Track credentialing status, expirations, and revalidation deadlines to ensure continuous network participation.
• Maintain accurate provider data in credentialing systems, CAQH, and internal databases.
• Serve as liaison with payers, providers, and internal teams to resolve credentialing and enrollment issues.
• Support new location enrollments and updates (TIN/NPI changes, service additions, address changes).
• Support new payer enrollments and updates (TIN/NPI changes, service additions, address changes).
• Ensure compliance with payer, state, and accreditation requirements.
• Maintain organized credentialing files and documentation audits.
• Collaborate with clinical, operations, intake and revenue cycle teams to prevent service disruptions.

Stay current on payer requirements, regulatory updates, and credentialing best practices.
 

Physical Demands: Work may require sitting for long periods of time; also stooping, bending, and stretching for files and supplies. Occasionally lifting files or paper weighing up to 40 pounds. Requires manual dexterity sufficient to work with children, operate a keyboard, telephone, copier, and other such office equipment. It is necessary to be on the phone and view and type on computer screens for long periods of time. 

Work Environment: 

      100% On-site - Center Base at our Peachtree Corners or Loganville Location

      Collaborative healthcare/ABA setting
      Standard business hours with occasional deadline-driven priorities

Non-Discrimination Statement

Atlanta Autism Center (AAC) is an equal opportunity employer. We are committed to building a diverse and inclusive workplace and do not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other characteristic protected by applicable federal, state, or local laws. AAC complies with applicable laws regarding accommodations for qualified individuals with disabilities. We encourage individuals of all backgrounds to apply.

 Qualifications & Skills:  

Bachelor’s degree 

 2+ years of ABA credentialing/enrollment experience required.

Knowledge of commercial insurance and Medicaid/CMO credentialing processes in the state of GA.

Experience with CAQH, NPI, PECOS, and payer portals preferred.

Strong attention to detail and organizational skills.

Ability to manage multiple deadlines and prioritize effectively.

Excellent communication and follow-up skills.

Proficiency in Microsoft Office and credentialing or billing systems.