Credentialing Specialist

The Credentialing Specialist supports Helping Hands Family’s mission by ensuring all providers are accurately credentialed and re-credentialed with health plans, enabling timely reimbursement and uninterrupted clinical care for clients. This role serves as a key connector between payor partners, clinical leadership, Revenue Cycle Management (RCM), and Human Resources (HR) to maintain compliance with payer requirements and credentialing standards. This is a fully remote position. 

Working in a fast-paced, detail-driven environment, the Credentialing Specialist manages multiple concurrent provider files and deadlines across several states. The position operates cross-functionally, requiring effective communication and relationship-building with Recruiting, HR, and Clinic Directors to support provider onboarding and operational efficiency.

Provider Credentialing and Enrollment

• Own the credentialing and re-credentialing process for all providers, ensuring timely and compliant enrollment with managed care organizations and other payors.
• Create and maintain provider CAQH and NPI applications and profiles to ensure credentialing accuracy and completeness.
• Research and document enrollment procedures for new markets and new payer relationships.
• Track, escalate, and resolve any credentialing issues to maintain compliance and adherence to deadlines.

Cross-Functional Collaboration and Communication

• Collaborate with HR, Recruiting, and Clinical Directors to ensure new providers receive accurate instructions and tools for credentialing during onboarding.
• Serve as the primary point of contact for providers regarding credentialing and enrollment inquiries, responding promptly and professionally.
• Interface with payer representatives to resolve application questions or delays.

Data Management and Reporting

• Maintain detailed records of credentialing status in the designated tracking system.
• Prepare and distribute monthly credentialing status reports for RCM and leadership teams.
• Send monthly reminders to providers regarding license renewals and expiring documents.
• Ensure data integrity and compliance in all credentialing records and systems.

Compliance and Quality Assurance

• Ensure all credentialing and enrollment processes comply with state and federal laws, including HIPAA and payer contract provisions.
• Maintain confidentiality of provider information, PHI, and PII.
• Support internal audits and continuous improvement initiatives related to credentialing procedures.

Operational Support

• Support additional RCM projects and initiatives as assigned by management to drive operational excellence and process improvement.

Required

• 3+ years of experience in Revenue Cycle Management (RCM) or provider credentialing.
• Certified Provider Credentialing Specialist (CPCS) certification preferred or equivalent substantial experience in credentialing.
• Extreme attention to detail and ability to manage multiple credentialing files simultaneously.
• Professional demeanor with excellent interpersonal, customer service, and verbal/written communication skills.
• Proficiency in Microsoft Office, primarily Excel.
• Thorough knowledge of compliance with state and federal laws, including HIPAA.
• Ability to handle confidential and sensitive information responsibly.
• Must submit to a background check and demonstrate disqualifying-free clearance.

Preferred

• Experience working in a multi-state or healthcare organization.
• Familiarity with payer systems and credentialing workflows across multiple markets.
• Experience with CAQH ProView and NPPES.

Helping Hands Family (“HHF”) provides Applied Behavior Analysis (ABA) therapy for children with Autism Spectrum Disorder (ASD). Our supportive, inclusive culture helps every individual reach their highest potential.

HHF is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military status.