The BY YOUR SIDE Credentialing Specialist coordinates all functions related to credentialing/recredentialing clinical staff and initiating/updating contracts with commercial insurance payers.

The Credentialing Specialist will also be responsible for assisting clinicians with keeping their CAQH up to date, monthly companywide status reports and persistently checking on the status of applications.

This is a 20 hour per week position that may vary.

• Work closely with HR to start the credentialing process for new hires including, but not limited to assisting with creating a CAQH database file and obtaining an NPI number, if needed.
• Follow each commercial payer’s unique process to add/remove clinicians from our contracts. Then track progress closely, often probing delay issues.
• Familiar with each payer’s online portal and use to its maximum capacity.
• Initiate and update BYS’s contracts with commercial insurance payers when moving an existing center, opening a new center or exploring a new state to enter into the market.
• Maintains current copies of state licenses, BCBA certifications, professional liability and any other required credentialing documents for all providers.
• Tracks license and certification expirations for all providers to ensure timely renewals.
• Assists Billing Specialists when claim denials involving credentialing issues occur.
• Ability to work independently, set priorities and meet deadlines.
• Communicates effectively across all departments, clinicians and insurance contacts.
• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
• The requirements listed above are representative of the knowledge, skill, and/or ability required.
• Uphold and maintain BYS core principles, policies, and procedures.
• Other duties may be assigned.

• High School diploma or equivalent is required. Associates Degree or Credentialing Certification preferred.
• Minimum two (2) years commercial insurance carrier credentialing required
• A working knowledge of CAQH is required.
• Ability to work effectively and efficiently with changing priorities and deadlines.

All your information will be kept confidential according to EEO guidelines.