Credentialing Coordinator

Job description

**We’re not just behavioral health people—we’re crisis people.** Connections Health Solutions is a leading provider of immediate-access behavioral health crisis care. Our team combines medical and recovery-oriented treatment to stabilize individuals in crisis and connect them to community-based resources for ongoing recovery. Founded by emergency room psychiatrists Dr. Chris Carson and Dr. Robert Williamson, our model is physician-led and data-driven, drawing upon more than 15 years of crisis care expertise. Recognized by SAMHSA and the National Council for Mental Wellbeing as a national best practice, we’ve delivered invaluable treatment to hundreds of thousands of individuals facing crises. Our commitment remains consistent, to improve access, inspire hope, and provide the right support. Our values shape our decisions, define our culture, and foster continuous learning and growth. We accept people as they are, creating safe spaces where they feel valued and respected. We inspire hope by walking with people side-by-side, showing them grace and compassion. We act with intention, holding ourselves and each other accountable, and doing the right thing. We work as one team, trusting and supporting each other. We embrace change and innovation, striving to find better ways to fulfill our mission. We are on a mission to change the face of behavioral health. Help us save lives and make a difference. **What You'll Do:** Under the direction of the Director, RCM Implementation, the **Credentialing Coordinator** manages the end-to-end credentialing, re-credentialing, and payer enrollment process for behavioral health providers, behavioral health support (BHS) staff, and facilities across Connections Health Solutions (CHS). This role serves as the subject matter expert for credentialing requirements across licensed clinical providers and non-licensed behavioral health support staff, ensuring accurate, timely, and compliant credentialing files that support billing, payer enrollment, and delegation of authority obligations. - **Provider Onboarding & Data Entry** - Manages new provider onboarding from initial HR/Talent Acquisition notification through completion of the provider’s Medallion profile. Enters and maintains provider information, including NPI, licensure, practice locations, and payer information, using the provider’s CV and supporting documentation. - **Provider Communication** - Initiates and tracks onboarding communications with providers to request required documentation, including CAQH, PECOS, state licenses, DEA registrations, board certifications, diplomas, and other required credentials. Conducts timely follow-up to ensure provider profiles reach 100% completion. - **Verbal Provider Support** - Initiates and responds to phone calls and text messages with physicians and other providers to explain credentialing and enrollment requirements, resolve outstanding items, and answer questions when direct communication is needed to keep the credentialing process moving forward. - **Provider Licensing Research** - Researches and interprets state licensing board requirements across provider types, including MDs, DOs, NPs, and PAs, to determine applicable licensure, supervision or collaborative agreement, and scope-of-practice requirements by market. Maintains current knowledge of regulatory and licensing board changes that may impact credentialing. - **Primary Source Verification (PSV)** - Monitors and completes required primary source verifications within the credentialing platform, including NPI, NPDB, Medicare/Medicaid opt-out, state licensure, DEA, OIG, and SAM checks. Escalates adverse findings through the appropriate credentialing committee review process prior to the provider’s start date. - **Malpractice & Insurance Coordination** - Coordinates with the organization’s insurance broker to add new providers to the applicable malpractice policy. Uploads resulting facesheets, certificates, and other required documentation to the credentialing platform and CAQH. - **Payer Enrollment & Maintenance** - Manages provider enrollment with applicable commercial and government payers by market. Monitors applications through completion, escalates stalled or non-compliant applications, and verifies effective dates, payer IDs, and recredentialing dates are accurately documented following approval. - **CAQH & Attestation Management** - Maintains and re-attests provider CAQH profiles, ensuring practice locations, liability coverage, and other required information remain current and accurate for payer enrollment. - **Multi-State & Telehealth Licensing** - Supports cross-state licensure and payer enrollment for telehealth providers, including updates to practice location and licensure information and coordination of additional malpractice insurance coverage for new markets. - **State-Specific Registration Processes** - Facilitates state and program-specific registration requirements, including prescriptive authority and collaborative agreement registration for advanced practice providers, state Medicaid portal enrollment, domain transfers, surrogacy requests, and Medicare enrollment through CMS/PECOS. - **BHS Staff Credentialing** - Manages NPI acquisition and state Medicaid enrollment for applicable behavioral health support staff. Tracks enrollment status through supplemental tracking tools and distributes recurring compliance reports, including missing NPI and Medicaid enrollment information, to HR and operational leadership for follow-up. - **Facility Credentialing** - Manages facility-level enrollment and maintenance within applicable state Medicaid systems, including linking servicing providers to facility records and maintaining accurate facility enrollment information. - **Offboarding**