Behavioral Health Credentialing/Contract Specialist-Future Hire

Behavioral Health Credentialing & Contract Specialist
(Provider, Group & Payer Credentialing; Contract Administration)
Full-Time, Hourly Employee

Position Information

Department: Operations / Clinical Administration

Employment Classification: Full-Time, Hourly Employee

Reports To: Chief Operating Officer / designated operations leader

Primary Practice Location: DE, NJ, NY, or PA

Work Arrangement: Remote

Anticipated Start Date: January 2027

Compensation: $38.00 per hour

This is a full-time, hourly employee position performed remotely. Schedule and workload are established based upon organizational needs, credentialing priorities, payer requirements, and the requirements of the position. The Behavioral Health Credentialing & Contract Specialist will support CRHE's provider and organizational credentialing activities across Delaware, Pennsylvania, New Jersey, New York City, and other jurisdictions as CRHE expands. Full-time employees are eligible for CRHE's employee benefits package, subject to applicable eligibility requirements, plan terms, and organizational policies.

Employee Benefits

Eligible full-time employees may receive:

• Medical insurance
• Dental insurance
• Vision insurance
• 401(k) retirement plan
• Wellness resources
• Training and continuing education opportunities
• Professional development opportunities
• Opportunities for advancement within the organization

The Center for Research & Health Equity (CRHE) is an integrated behavioral healthcare organization committed to expanding equitable access to high-quality mental health, substance use disorder, and co-occurring disorder treatment for adults. Through interdisciplinary collaboration, culturally responsive care, evidence-based practice, and community partnerships, CRHE seeks to improve behavioral health outcomes while addressing the social and structural factors that influence health and recovery.

CRHE provides outpatient behavioral health services, intensive outpatient programming, partial hospitalization programming, psychiatric medication management, integrated care coordination, and community-based partnerships designed to improve long-term health, recovery, and quality of life.

The Behavioral Health Credentialing & Contract Specialist supports CRHE's ability to employ, contract with, credential, enroll, and maintain behavioral health providers and organizational entities across multiple jurisdictions and payer systems. The position is responsible for provider and group credentialing, payer enrollment, recredentialing, roster maintenance, credentialing documentation, contract tracking, and related administrative functions.

The Specialist must understand the distinction between individual provider credentialing and organizational/group enrollment and must be able to manage both. The role requires strong attention to detail, knowledge of behavioral health provider types, payer requirements, state licensure requirements, and the documentation needed to maintain active participation.

The position will be particularly important as CRHE expands across Delaware, Pennsylvania, New Jersey, New York City, and other jurisdictions. The Specialist will maintain centralized credentialing records and proactively track expirations, recredentialing cycles, payer requirements, contract terms, and provider status.

This position operates within CRHE's organizational policies, applicable federal and state requirements, payer requirements, contractual requirements, confidentiality standards, and the scope of responsibilities established for the position.

Individual Provider Credentialing

• Coordinate initial credentialing and recredentialing for CRHE providers.
• Collect and verify licenses, certifications, education, work history, malpractice coverage, NPI information, CAQH data, and other required documentation.
• Conduct or coordinate primary-source verification as required.
• Monitor provider licenses and certifications and maintain expiration calendars.
• Coordinate provider additions, terminations, demographic changes, and payer roster updates.

Group & Organizational Credentialing

• Credential CRHE organizational and group entities with applicable payers.
• Maintain organizational NPI, taxonomy, ownership, location, accreditation/licensure, and tax documentation.
• Coordinate group enrollment and linking of rendering providers to the appropriate group/entity and locations.
• Maintain payer-specific group enrollment records and revalidation/recredentialing schedules.
• Ensure organizational and provider information is consistent across payer systems.

Payer Enrollment & Contracting

• Prepare and submit payer enrollment applications and supporting documentation.
• Track enrollment status, effective dates, participation status, and payer correspondence.
• Maintain payer contracts, amendments, fee schedules, participation agreements, and renewal dates.
• Coordinate with leadership regarding payer contracting opportunities and documentation requests.
• Maintain a centralized payer matrix showing CRHE entities, locations, providers, services, and participation status.

Compliance & Monitoring

• Monitor provider and organizational sanctions/exclusion requirements as assigned.
• Track state license and credential requirements across operating jurisdictions.
• Maintain audit-ready credentialing files.
• Identify credentialing gaps that may delay billing or service delivery and escalate them promptly.
• Support internal and external credentialing audits.

Operations & Reporting

• Develop and maintain credentialing trackers and dashboards.
• Provide regular reports on pending enrollments, expirations, recredentialing, payer participation, and outstanding documentation.
• Coordinate with HR, billing, clinical leadership, and operations regarding provider status.
• Recommend process improvements to reduce credentialing and enrollment delays.

Minimum Qualifications

• Bachelor's degree in healthcare administration, health information management, business administration, human resources, public health, behavioral health administration, or a related field preferred.
• Associate degree plus substantial relevant credentialing, payer enrollment, healthcare administration, or behavioral health operations experience may be considered.
• At least 2 years of experience in healthcare credentialing, payer enrollment, provider enrollment, medical staff services, healthcare contracting, or a closely related function.
• Demonstrated experience credentialing individual behavioral health providers and organizational/group entities.
• Experience with CAQH and payer enrollment/credentialing systems.
• Working knowledge of NPI, taxonomy, licensure verification, sanctions/exclusion screening, provider rosters, recredentialing, and payer enrollment documentation.
• Experience tracking payer contracts, amendments, participation status, fee schedules, and renewal requirements preferred.
• Strong proficiency with spreadsheets, document management, and electronic databases.

• Provider and group credentialing
• Payer enrollment
• CAQH and credentialing databases
• NPI and taxonomy concepts
• Healthcare contracting
• Primary-source verification
• Document management
• Spreadsheet/database management
• Regulatory tracking
• High-level attention to detail

• Demonstrate professionalism, integrity, accountability, and respect in all interactions.
• Maintain confidentiality and protect sensitive client, employee, organizational, and business information.
• Communicate clearly and respectfully with clients, families, referral sources, vendors, colleagues, and community partners as applicable to the role.
• Work collaboratively within CRHE's interdisciplinary and administrative environment.
• Support CRHE's commitment to culturally responsive, equitable, evidence-informed behavioral healthcare.
• Complete assigned documentation and administrative tasks accurately and within organizational timeframes.
• Seek consultation or escalate concerns when an issue exceeds the scope of the position.
• Participate in required training, professional development, and organizational activities applicable to the position.

CRHE is committed to supporting the professional growth and development of its employees. Full-time employees may have opportunities to participate in training, continuing education, professional development activities, and cross-functional organizational initiatives.

As CRHE expands its provider network, payer relationships, service locations, and organizational infrastructure, employees may have opportunities to assume increased credentialing, contracting, payer relations, or operational responsibilities and advance into higher-level administrative, credentialing, contracting, or supervisory roles based upon demonstrated performance, qualifications, organizational needs, and available positions.

The position is remote and requires sustained computer use, virtual communication, document review, and electronic database work. Reasonable accommodations may be provided.

The Center for Research & Health Equity (CRHE) is committed to fostering a professional environment grounded in integrity, collaboration, innovation, accountability, and respect. CRHE employs qualified professionals based upon education, experience, demonstrated competency, organizational needs, and applicable employment requirements. We are committed to culturally responsive, evidence-informed behavioral healthcare that reflects the diverse communities we serve and supports equitable access to high-quality mental health and substance use treatment.