Credentialing Manager (ABA Healthcare)

Location: Remote (India)

Job Type: Independent Contractor

Work Schedule: Monday–Friday | U.S. Business Hours

Fiesta Health is a rapidly growing ABA provider serving children with autism throughout Georgia. As we continue to expand, we are seeking an experienced Credentialing Manager to oversee all aspects of provider credentialing, payer enrollment, contract management, and payer relationship management.

This is not an entry-level credentialing position. We are looking for someone with extensive experience credentialing BCBAs and ABA providers with Medicaid and commercial insurance companies in the United States.

The ideal candidate is comfortable communicating directly with insurance companies, resolving enrollment issues, negotiating contracts, and ensuring providers remain credentialed and in-network.

The Credentialing Manager is responsible for managing the complete credentialing lifecycle for all providers and clinic locations.

This includes:

• Initial credentialing
• Recredentialing
• Medicaid enrollments
• Commercial payer enrollments
• CAQH management
• Contract negotiations
• Rate negotiations
• Payer issue resolution
• Provider roster maintenance
• Ongoing payer relationship management

This role requires someone who is proactive, persistent, highly organized, and comfortable spending a significant portion of the day communicating directly with insurance companies.

Key Responsibilities

Provider Credentialing

• Complete initial credentialing for BCBAs, psychologists, physicians, and other providers.
• Manage provider recredentialing.
• Submit provider demographic updates.
• Process provider additions and terminations.
• Maintain provider credentialing records.

Manage enrollments with Medicaid and commercial payers, including:

• Georgia Medicaid (GAMMIS)
• CareSource
• Amerigroup
• Anthem BCBS
• Aetna
• Cigna / Evernorth
• UnitedHealthcare / Optum
• Humana
• Molina
• Additional commercial insurance plans

• Contact insurance companies to resolve credentialing delays.
• Escalate unresolved enrollment issues.
• Follow up on pending applications.
• Resolve provider roster discrepancies.
• Investigate payer denials related to credentialing.
• Coordinate with payer representatives to ensure timely approvals.

• Review provider participation agreements.
• Negotiate reimbursement rates when appropriate.
• Negotiate contract terms with commercial payers.
• Track contract effective dates.
• Monitor contract renewal deadlines.
• Maintain executed payer agreements.

• Maintain CAQH profiles.
• Ensure provider documents remain current.
• Track expiring licenses, malpractice insurance, DEA (if applicable), and certifications.
• Maintain credentialing database.

• Maintain credentialing tracker.
• Report application status.
• Monitor turnaround times.
• Track payer approval timelines.
• Identify credentialing bottlenecks.

• Minimum 5 years of U.S. healthcare credentialing experience
• Minimum 3 years of ABA credentialing experience
• Extensive experience credentialing:
  • BCBAs
  • Psychologists
  • Physicians
  • ABA clinics
• Experience credentialing with both Medicaid and commercial insurance companies.
• Experience managing provider enrollments from start to finish.
• Experience calling insurance companies to resolve credentialing issues.
• Experience following up on delayed applications.
• Experience maintaining CAQH.
• Excellent spoken and written English.
• Strong negotiation skills.
• Excellent organizational skills.

Experience credentialing with:

• Georgia Medicaid (GAMMIS)
• ABA organizations
• Multi-state provider groups
• Multi-location clinics

Experience using:

• CAQH
• Availity
• Provider portals
• Microsoft Excel
• Google Sheets
• Monday.com (preferred)

• Outstanding verbal communication.
• Strong phone etiquette.
• Ability to confidently communicate with payer representatives.
• Highly organized.
• Strong follow-up skills.
• Detail-oriented.
• Excellent time management.
• Problem-solving mindset.
• Ability to manage multiple credentialing projects simultaneously.

• Laptop with at least:
  • Intel Core i5 (or equivalent)
  • 8 GB RAM
  • Webcam
• Stable high-speed internet.
• Quiet workspace for daily phone calls.

• Competitive (based on experience).
• Remote.
• Independent Contractor.