Behavioral Health Contracting & Credentialing Specialist

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: TYPE OF WORK

Any

: SALARY

$500 - $1000 USD/Month Based on Exp.

: HOURS PER WEEK

40

: DATE UPDATED

Aug 7, 2026

JOB OVERVIEW

Job Summary

Manage end-to-end enrollment for behavioral health clinicians (LCSWs, LMFTs, LPCs, PsyDs, Psychiatrists) into commercial and Medicaid/Medicare insurance panels.

Core Responsibilities

Audit, update, and re-attest provider profiles on CAQH ProView to ensure total data accuracy.

Review and submit initial contracting requests, fee schedule updates, and single-case agreements with managed care organizations.

Compliance Audits: Monitor primary source verifications including state licenses, DEA registrations, and malpractice insurance caps, ensure expirables don't lapse.

Roster Maintenance: Submit regular provider roster updates to insurance carriers to ensure accurate online directories and prevent claim denials.

Primary Source Verification: Validate provider licensures, certifications, board credentials, education, and work history.
Application Processing: Complete and submit high-volume enrollment applications for government (Medicare, Medicaid) and commercial payers.

Database Maintenance: Update and maintain precise data fields across CAQH, PECOS, NPPES, and internal software (Credentialing Spectrum).

Expiration Tracking: Proactively monitor provider expiration dates for DEA, state licenses, and malpractice insurance.
Discrepancy Resolution: Identify potential onboarding delays, research missing file documentation, and resolve issues.

Payer Follow-Up: Contact Managed Care Organizations (MCOs) and commercial plans regularly to track application statuses.

Audit Support: Assist in preparing required provider files and scoring checklists for accreditation reviews and audits.
Client Communication: Serve as a primary point of contact for providers, medical staff offices, and client leadership.

Required Skills & Qualifications
Education: High school diploma or equivalent required; Associate or Bachelor's degree preferred.

Experience: Minimum 3–5 years of dedicated insurance contracting and credentialing experience specifically within mental/behavioral health.

Technical Skills: Proficiency using specialized credentialing software (Credentialing Spectrum) and Google Sheets, Google Drive, FrontAPP, Mastery of CAQH, PECOS, NPPES (NPI registry), and state-specific Medicaid portals.

Regulatory Knowledge: Solid understanding of NCQA, Joint Commission, CMS, and state licensing board requirements.

Data Integrity: Extreme attention to detail with an exceptionally low error rate in high-volume data entry.

Communication: Clear, professional verbal and written communication skills for interacting with providers and insurance companies.

Confidentiality: Demonstrated capability to securely manage and process highly sensitive, confidential personal data.

Core Strengths: Relentless attention to detail, strong follow-up habits with insurance payers, and clear communication skills.

Preferred Certifications
Certified Provider Credentialing Specialist (CPCS) through NAMSS.
CPES (Certified Provider Enrollment Specialist)
CPMSM (Certified Professional Medical Services Management)

Preferred Training:
AAPC Credentialing Specialist Certificate
CMSC (Certified Medical Staff Coordinator)

***When Applying for Job please list at least 2 reasons why Provider enrollment insurance applications get rejected in behavioral health. Those who don't will be automatically disqualified.***

SKILL REQUIREMENT

Healthcare Documentation Credentialing

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Behavioral Health Contracting & Credentialing Specialist

Please login or register as jobseeker to apply for this job.

TYPE OF WORK

SALARY

HOURS PER WEEK

DATE UPDATED

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