Credentialing & Contracting Specialist en MIND BODY OPTIMIZATION 1

Description

Position Summary
The Credentialing Specialist I plays a vital role in ensuring our clinical team meets regulatory, payer, and organizational standards. This position is responsible for the full lifecycle of provider credentialing and re-credentialing, managing payer enrollments, and maintaining compliance with federal, state, and payer-specific requirements.

Key Responsibilities

• Manage initial credentialing, re-credentialing, and privileging processes for behavioral health providers (psychiatrists, nurse practitioners, therapists, etc.).
• Coordinate payer enrollment, revalidation, and demographic updates with commercial insurers.
• Maintain up-to-date provider data in internal credentialing and EHR systems.
• Track and ensure timely renewal of licenses, certifications, DEA, malpractice insurance, and other credentials.
• Monitor and maintain compliance with NCQA, CMS, and state-specific standards.
• Respond to internal and external credentialing inquiries promptly and professionally.
• Collaborate with Human Resources, Clinical Leadership, and Billing/Revenue Cycle teams to ensure smooth onboarding and billing readiness for new hires.
• Prepare credentialing files for audits and participate in quality improvement initiatives.

Qualifications

• Associate’s or Bachelor’s degree in healthcare administration, business, or related field preferred.
• 2+ years of credentialing experience in a healthcare setting (behavioral health experience highly desirable).
• Working knowledge of CAQH, PECOS, NPPES, and payer portals.
• Familiarity with state/federal regulations, including Medicaid and Medicare guidelines.
• Strong attention to detail and excellent organizational skills.
• Proficient in Microsoft Office and credentialing software platforms.
• Ability to manage multiple priorities and meet deadlines.
• Excellent communication and collaboration skills.

Preferred Qualifications

• CPCS or CPMSM certification through NAMSS.
• Experience working in a multi-state behavioral health organization.
• Familiarity with EHRs and practice management systems.

Qualifications