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ABA Director of Credentialing

2 hours, 27 minutes ago
United States
Full-time
Senior
Compliance Manager
Operations
Salesforce
Apply Now
Coyne & Associates

Coyne & Associates

Coyne & Associates provides evidence-based Applied Behavior Analysis (ABA) intervention services to support young children with autism and other developmental delays across Southern California.

Diversified Consumer Services
51-250
View All Jobs

Description

  • Oversee end-to-end provider credentialing and recredentialing across four companies and 10 states.
  • Lead provider enrollment, revalidation, and maintenance with Medicaid, Medicare, MCOs, Regional Centers, and commercial payers.
  • Maintain current provider records, licenses, certifications, and credentialing documentation.
  • Develop credentialing performance metrics, service-level standards, quality benchmarks, and departmental goals.
  • Ensure compliance with federal, state, payer, and accreditation requirements through audits, monitoring, and corrective action plans.
  • Monitor SAM, OIG exclusions, state sanctions and exclusions, Open Payments, and Medicare/Medicaid Opt-Out status.
  • Lead payer contracting, contract implementation, negotiations, and provider network expansion initiatives.
  • Establish and maintain policies, SOPs, governance processes, and standardized workflows.
  • Lead ACQ accreditation preparation and ongoing compliance activities while maintaining audit readiness.
  • Manage, mentor, train, and develop credentialing, enrollment, and compliance staff.

Requirements

  • Bachelor’s degree in Healthcare Administration, Business Administration, Public Health, or a related field; master’s degree preferred.
  • At least 7 years of experience in provider credentialing, healthcare compliance, provider enrollment, or payer contracting.
  • Experience in ABA, behavioral health, or healthcare services organizations.
  • Demonstrated experience managing multi-state credentialing and payer enrollment operations.
  • Strong knowledge of Medicaid, Medicare, commercial payer credentialing, and managed care requirements.
  • Proficiency with CAQH, NPPES, CMS I&A, Availity, Salesforce, CentralReach, provider enrollment systems, CMS platforms, and Microsoft Office Suite.
  • Advanced Excel skills preferred.
  • Experience with payer contracting, accreditation, compliance audits, policy governance, and regulatory monitoring preferred.

Benefits

  • Flexible remote work environment.
  • Competitive salary with performance-based incentives.
  • Comprehensive health, dental, chiropractic, vision, life, accident, critical illness, and hospital confinement insurance.
  • 401(k), pet insurance, paid time off, and nine company-paid holidays annually.
  • Professional development assistance and leadership development opportunities.
  • Tuition reduction programs through affiliated university partners.
  • Collaborative and supportive work culture.
  • Employee referral program.

Interested in this position?

Apply directly on the company website

Apply Now

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