About This Role
This part-time Credentialing Specialist role supports clinicians and expands access to quality behavioral health services. The specialist manages provider credentialing, enrollment, and recredentialing with various insurance plans and third-party payers, ensuring uninterrupted provider participation, compliance, and reimbursement. The position works 20 hours a week and suits a detail-oriented, organized individual committed to the mission of serving individuals and families.
Responsibilities
- Coordinate provider enrollment, credentialing, recredentialing, and disenrollment activities for Medicare, Medicaid, commercial insurance payers, and other third-party reimbursement programs
- Prepare, submit, and track credentialing, recredentialing, payer enrollment, demographic update, and provider maintenance applications through approval and implementation
- Maintain accurate and complete provider records, credentialing files, and enrollment documentation within credentialing databases, payer portals, and other designated systems
- Monitor and track the status of credentialing applications, payer enrollments, and provider participation to ensure timely completion and uninterrupted network participation
- Monitor expiration and renewal dates for licenses, certifications, malpractice insurance, DEA registrations, and other required credentials, obtaining updated documentation as necessary
- Research payer requirements, regulatory changes, and enrollment guidelines, communicating updates that may impact provider participation, reimbursement, or compliance
- Collaborate with providers, payer representatives, billing staff, and internal stakeholders to resolve credentialing discrepancies, enrollment issues, and participation delays
- Verify payer participation status, effective dates, and provider enrollment information to support accurate billing and reimbursement processes
- Coordinate the addition of new providers, service locations, and provider changes with applicable payer networks
- Prepare credentialing reports, enrollment status updates, and related data for leadership and operational stakeholders
- Support internal audits, external reviews, accreditation activities, and compliance initiatives by maintaining complete, accurate, and audit-ready documentation
- Perform other related duties as assigned
Requirements
- High school diploma or equivalent required
- Associate's degree preferred
- Minimum of 4 years of healthcare credentialing, provider enrollment, medical billing, or related experience preferred
- Experience managing provider enrollment, credentialing, and recredentialing processes
- Knowledge of Medicare, Medicaid, commercial insurance, and other third-party payer credentialing requirements
- Experience using CAQH, NPPES, PECOS, and payer enrollment portals
- Experience utilizing credentialing, provider enrollment, practice management, or related healthcare software
- Familiarity with behavioral health, counseling, healthcare, or medical practice operations
Benefits
- Generous parental leave policies
- Flexible working arrangements
- Group life insurance
- Permanent health insurance
- Dedicated support to help find the right child care or elder care
Important Details
- Schedule: 20 hours per week
About the Company
Saint Louis Counseling supports healing and improved mental health for families and children of all backgrounds through professional counseling and psychiatric services. It operates eight offices throughout metropolitan St. Louis, and its School Partnership Program therapists provide onsite services to students at more than 100 schools as well as children who are homeless living at area shelters. The mission is to bring the healing, help, and hope of Jesus Christ to those in need with a compassionate, caring presence.
