Credentialing Supervisor bei Cultivate Behavioral Health

CREDENTIALING SUPERVISOR

JOB DESCRIPTION

Last updated: August, 2025

Specifications are intended to reflect all duties performed within the job.

 Job Summary

 The Credentialing Supervisor is responsible for all the provider credentialing activities at Cultivate by managing a team of credentialing coordinators along with carrying their own provider caseload as necessary.  This includes ABA and mental health providers in all states in which Cultivate operates. Ensures that the designated staff assigned to clinics and mental health facilities are properly trained, licensed and certified as mandated by state and federal regulations.

Duties and Responsibilities                                                                                                                  

·       Ensures that new and existing providers are credentialed with the appropriate health plans for their practice location

·       Establish SLA targets for credentialing of new and existing providers for each payer contract and manage the credentialing team to deliver on these SLA’s and develop strategies for SLA improvement and gap closure

·       Responsible for managing credentialing coordinators caseload in a balanced and efficient manner in order to ensure meeting established SLAs for credentialing of new and existing providers

·       Compiles and maintains current and accurate data for all assigned providers by leveraging credentialing management software CredentialStream, and responsible for user administration within the system

·       Completes provider credentialing and re-credentialing applications and CAQH attestations; monitors applications and follows-up, as needed.

·       Partners with the contracting team and rate governance team to drive efficiencies and improvements to contracts and payer rates

·       Maintains knowledge of current health plans and company requirements for credentialing providers

·       Manages and leverage the DOMO visualization and reporting platform to ensure accuracy and adherence to established SLA’s

·       Provides regular credentialing status reports to executive and operations management teams which includes escalation of key challenges preventing credentialing execution

·       Partners with RCM team on a daily/weekly basis to ensure accuracy of billing and prevention of billing/servicing of un-credentialed providers

·       Create accounts for providers, as needed

·       Understands and adheres to HIPAA policies

·       Adheres to Cultivate Behavioral Management Corp. policies and procedures

·        Performs other duties as assigned

Qualifications

·       Associate degree or equivalent training

·       Minimum of three (3) to five (5) years of experience

·       Demonstrated experience working with State Medicaid agencies through contracting and enrollment process for Texas, Florida, Connecticut, Ohio, Kentucky, Wisconsin, Tennessee, Colorado, Missouri, Oklahoma, Kansas and Illinois is preferred.

·       Credentialing certification is preferred

·       Process driven and detail-oriented

·       Excellent organizational and time management skills including the ability to effectively multi-task and prioritize appropriately to deliver timely results

·       Highly motivated and energetic during work hours

·       Communication skills, both oral and written, that are clear, confident, exhibit leadership, professionalism, empathy, and inspire confidence

·       Advanced problem-solving skills and the ability to think ‘big picture’ and execute defined goals and plans

·       Ability to work full-time (40 hours/week), including some flexibility regarding schedule changes required to accommodate patient and staff needs

·       Basic understanding of technology utilized in the field of ABA, including data collection software that leads to the delivery of high-quality services

·       Experience and competency with Microsoft Office Suite including Word, Excel, PowerPoint, and Outlook email and Calendar

·       Ability to successfully complete and pass a Background and Drug Screen

Working conditions

·       Ability to bend, kneel, crouch, and stand as well as an ability to lift items up to 25 lbs.

·       Endurance to move rapidly from a seated position to a standing position to perform required tasks

·       Requires eye-hand coordination and manual dexterity enough to operate office equipment, etc.

·       Clerical responsibilities and administrative work require appropriate levels of vision and hearing abilities

·       Ability to communicate effectively using a variety of audio and video meeting platforms and electronic devices