Credentialling Specialist

Credentialing Specialist   Location: Claratel Winn Way- 445 Winn Way, Decatur, GA 30030 Hours: Monday – Friday 8:00am- 5:00pm (Hybrid) Claratel Behavioral Health is seeking a dedicated and experienced Credentialing Specialist. This role is responsible for managing provider credentialing, payer enrollment, and maintaining payer relationships.  The Credentialing Specialist serves as the primary liaison between the agency and payer therefore, playing a key role in optimizing revenue cycle performance.   Key Responsibilities: * Build and maintain strong relationships with Medicaid, Medicaid CMOs, and Commercial Payers * Serve as the primary point of contact for payer communications, issue resolution, and escalations * Attend Medicaid, CMO, and payer sponsored meetings and trainings * Manage end-to-end provider credentialing and recredentialing processes * Complete, track, and monitor payer enrollment applications for new payer contracts * Maintain accurate and up-to-date provider data * Maintain provider profiles in CAQH database * Enroll and manage staff access in payer portals including: * GAMMIS * Availity * Palmetto GBA Portal * Ensure timely completion of attestations and revalidations * Monitor provider licensure, certifications, and renewals to ensure ongoing compliance * Track and verify sanctions, exclusions, and disciplinary actions (OIG, SAM, State Boards) * Monitor associate-level staff working toward full licensure and ensure proper payer alignment * Maintain all required credentialing documentation * Collaborate with HR and Clinical Leadership to support provider onboarding * Ensure data integrity and consistency across EHR, payer systems, and credentialing platforms * Provide regular status updates and timelines for leadership * Track and report on key credentialing and enrollment metrics (turnaround time, enrollment lag, recredentialing compliance)     Skills and Competencies:   * In-depth knowledge of credentialing, payer enrollment, and regulatory requirements * Proficient in CAQH maintenance and management * Intermediate proficiency in Excel * Strong analytical and problem-solving skills * Ability to develop strong collaborative working relationships with internal partners * Ability to manage multiple priorities simultaneously with strict and competing deadlines * Ability to adapt quickly to changing priorities * Highly self-motivated with strong organizational skills and attention to detail * Exercise sound judgement, including appropriate escalation of issues when necessary * Excellent interpersonal skills including the ability to interact effectively and professionally with individuals at all levels; both internal and external * Embraces and leverages technology to enhance efficiency * Must possess strong ethics and a high level of personal and professional integrity   Preferred Experience: * Minimum 2-3 years of credentialing experience in a multi-provider environment required * Preferred but not required: CPCS- Certified Provider Credentialing Specialist

Kyo is a leading provider of Applied Behavior Analysis (ABA) therapy, dedicated to empowering children with autism and their families to achieve meaningful outcomes. Since 2005, we have partnered with thousands of families across 11 states, delivering effective, convenient, and child-centric ABA therapy designed around each child’s unique strengths, needs and goals. At Kyo, our mission is rooted in a commitment to making every moment count for the children and families we support. Pay Range: $27.88 - $31.25 Candidates must reside in one of the following states: AZ, CA, CO, FL, GA, OR, TX, UT, TN, TX, WA Primary job responsibilities may include, but are not limited to: * Managing credentialing, recredentialing, and licensure process for clinical staff with health insurance plans, certification boards and other agencies * Ensuring compliance with various state, federal and payer requirements * Responsible for pre-application intake, monitoring, application submission and follow up * Maintaining an efficient and compliant on-boarding process * Inputing/Updating provider credential databases CAQH and NPPES * Ongoing monitoring of clinical staff’s credentials to ensure licenses and certifications are current and active * Working closely with internal departments to exchange provider information and follow up on inconsistencies * Assisting with other miscellaneous duties in the Revenue and Contracting department  Qualifications: * Bachelor's Degree preferred but not required * Demonstrated proficiency with productivity software and project management software (Microsoft Office, G Suite, Asana) * Database management skills including querying, reporting, and document generation * Ability to work independently and as part of a team * Ability to work in a fast paced, expanding organization * Strong knowledge of the credentialing process and accreditation and regulatory standards. Ability to lead and facilitate processes through influence and collaboration * Working knowledge of Medical Terminology * Strong organization and verbal communication skills, attention to details required * Ability to use independent judgment to manage and impart confidential information * Demonstrated problem-solving skills and initiative to analyze and disseminate relevant credentialing data across internal company departments * Ability to make priority determinations without direct supervision * Preferred: Experience with provider credential databases CAQH, NPPES * Preferred Experience with JIRA * Preferred: Experience with HIPAA and compliance-sensitive environments * Willingness and ability to provide proof of completed COVID-19 vaccination and booster (if eligible), no later than your scheduled start date. If you believe you are entitled to either a medical or religious exemption to our vaccination requirement, please notify your Kyo interviewer immediately so that your situation can be evaluated by Human Resources  Physical Requirements: * Must be able to sit and use a computer for extended periods of time * Exhibit manual dexterity to regularly use and enter data into a computer/tablet/phone * Ability to read and interpret documents in the English language such as employee handbooks, training materials and procedure manuals * No or very limited exposure to physical risk * No or very limited physical effort required * Ability to perform data entry, operate standard office equipment e.g. copiers, fax * Willingness and ability to provide proof of completed COVID-19 vaccination and booster (if eligible), no later than your scheduled start date. (If you believe you are entitled to either a medical or religious exemption to our vaccination requirement, please notify your Kyo recruiter immediately so that your request may be reviewed by HR.)   Apply today to meet with our Talent team and learn more! [https://assets.unlayer.com/projects/37000/1671218355666-Screen%20Shot%202022-12-16%20at%2011.19.02%20AM.png]