Credentialing Specialist
$57,990–$65,000 year
On-siteAustin, Texas, United States
Job Summary
Manage credentialing, recredentialing, and licensure processes for clinical staff with health insurance plans, certification boards, and other agencies. Ensure compliance with state, federal, and payer requirements while handling pre-application intake, monitoring, submission, and follow-up. Maintain an efficient on-boarding process by inputting and updating provider credentials in CAQH and NPPES databases. Monitor clinical staff credentials to ensure licenses and certifications remain current and active, working with internal departments to resolve inconsistencies. Assist with miscellaneous duties in the Revenue and Contracting department. This role supports Kyo's mission to empower children with autism across 11 states through effective, child-centric ABA therapy.
Required Qualifications
- Bachelor's Degree preferred but not required
- Demonstrated proficiency with productivity software and project management software (Microsoft Office, G Suite, Asana)
- Database management skills including querying, reporting, and document generation
- Ability to work independently and as part of a team
- Ability to work in a fast paced, expanding organization
- Strong knowledge of the credentialing process and accreditation and regulatory standards
- Ability to lead and facilitate processes through influence and collaboration
- Working knowledge of Medical Terminology
- Strong organization and verbal communication skills, attention to details required
- Ability to use independent judgment to manage and impart confidential information
- Demonstrated problem-solving skills and initiative to analyze and disseminate relevant credentialing data across internal company departments
- Ability to make priority determinations without direct supervision
- Willingness and ability to provide proof of completed COVID-19 vaccination and booster (if eligible), no later than your scheduled start date
- Must be able to sit and use a computer for extended periods of time
- Exhibit manual dexterity to regularly use and enter data into a computer/tablet/phone
- Ability to read and interpret documents in the English language such as employee handbooks, training materials and procedure manuals
- No or very limited exposure to physical risk
- No or very limited physical effort required
- Ability to perform data entry, operate standard office equipment e.g. copiers, fax
Desired Qualifications
- Experience with provider credential databases CAQH, NPPES
- Experience with JIRA
- Experience with HIPAA and compliance-sensitive environments
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