Credentialing Specialist

Tiny steps bring big results at Little Leaves Behavioral Services for children, families, and team members alike. Our passionate clinicians and technicians work one-on-one with children with autism spectrum disorder (ASD) ages 1 to 6 to prepare them to thrive in school and life. This is a journey of impact and meaning. Achieve positive outcomes, pursue meaningful development, and realize purposeful balance as part of our team.  

Little Leaves provides full insurance support to families who seek our services. The Credentialing Specialist is responsible for managing the end-to-end provider credentialing and enrollment process to ensure all providers are properly enrolled, affiliated, and eligible to bill for services.

This role is critical to maintaining billing readiness, compliance, and revenue flow by ensuring providers are credentialed accurately and timely across MD, VA, and FL markets.

Responsibilities

· Manage initial credentialing, recredentialing, and revalidation for all providers across multiple payers and states (MD, VA, FL)

· Maintain and update CAQH profiles, ensuring accuracy of provider demographics, licensure, and documentation

· Ensure providers are properly affiliated with correct TINs, service locations, and state licensure requirements

· Track and manage all applications using a centralized credentialing tracker

· Proactively follow up with payers on pending applications (30/60/90+ days)

· Escalate credentialing delays and unresolved issues through payer channels and leadership

· Collaborate with billing, authorization, and clinical teams to ensure providers are cleared for billing

· Identify and resolve credentialing discrepancies that may impact claims submission or reimbursement

· Maintain accurate documentation of credentialing activities in internal systems

· Support onboarding of new providers to ensure timely credentialing and minimal service disruption

· Assist with payer demographic updates, roster submissions, and contract-related updates

· Review and respond to payer correspondence related to credentialing status

· Perform audits to ensure alignment between credentialing records and billing systems

· Performs other duties as assigned

Desired Qualifications

· 2+ years of provider credentialing experience (behavioral health or ABA preferred)

· Experience working with commercial payers (UHC/Optum, Aetna, Cigna, BCBS, Kaiser, etc.)

· Strong knowledge of CAQH management and provider enrollment processes

· Experience with multi-state credentialing (MD, VA, FL preferred)

· Understanding of state-specific licensure and payer enrollment requirements

· Highly organized with strong attention to detail and follow-through

· Strong communication and problem-solving skills

· Experience with practice management systems (e.g., Central Reach, Motivity) preferred

· Proficiency in Excel and tracking tools

· Ability to manage high-volume workflows and meet deadlines

· Ability to maintain confidentiality and comply with HIPAA regulations