Credentialing Specialist- 130703
Hybrid · Decatur, Georgia, United States
Job Summary
Credentialing Specialist at Claratel Behavioral Health based in Decatur, GA, responsible for end-to-end credentialing, payer enrollment, and maintaining payer relationships to optimize revenue cycle. Key duties include managing Medicaid, CMOs, and commercial payer communications; coordinating end-to-end credentialing/recredentialing; processing payer enrollment applications; maintaining provider data and CAQH profiles; ensuring licensure, certifications, and renewals; tracking sanctions/exclusions; supporting onboarding with HR/Clinical Leadership; and reporting credentialing metrics. Requires experience in CAQH maintenance, payer enrollment, strong analytical/problem-solving skills, ability to work with multiple priorities, and adherence to regulatory requirements; pre-employment drug screening, criminal history checks, and E-Verify participation are required. Hybrid work arrangement with a local in-person site: Decatur, GA.
Required Qualifications
- Minimum 2-3 years of credentialing experience in a multi-provider environment
- CAQH maintenance and management
- Pre-employment drug screening
- Criminal history background check
- Claratel participates in E-Verify (Company ID: 226305)
- Strong ethics and integrity
- Excellent interpersonal skills and ability to interact with internal and external stakeholders
- Ability to manage multiple priorities with deadlines
- Knowledge of Medicaid, Medicaid CMOs, commercial payers, and payer enrollment processes
- Experience with payer portals (GAMMIS, Availity, Palmetto GBA) and payer data quality
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