[Hiring] Behavioral Health Credentialing and Contract Specialist @Center for Racial & Health Equity LLC

Role Description

The Behavioral Health Credentialing & Contract Specialist supports CRHE's ability to employ, contract with, credential, enroll, and maintain behavioral health providers and organizational entities across multiple jurisdictions and payer systems. The position is responsible for:

• Provider and group credentialing
• Payer enrollment
• Recredentialing
• Roster maintenance
• Credentialing documentation
• Contract tracking
• Related administrative functions

The Specialist must understand the distinction between individual provider credentialing and organizational/group enrollment and must be able to manage both. The role requires strong attention to detail, knowledge of behavioral health provider types, payer requirements, state licensure requirements, and the documentation needed to maintain active participation.

The position will be particularly important as CRHE expands across Delaware, Pennsylvania, New Jersey, New York City, and other jurisdictions. The Specialist will maintain centralized credentialing records and proactively track expirations, recredentialing cycles, payer requirements, contract terms, and provider status.

Qualifications

• Bachelor's degree in healthcare administration, health information management, business administration, human resources, public health, behavioral health administration, or a related field preferred
• Associate degree plus substantial relevant credentialing, payer enrollment, healthcare administration, or behavioral health operations experience may be considered
• At least 2 years of experience in healthcare credentialing, payer enrollment, provider enrollment, medical staff services, healthcare contracting, or a closely related function
• Demonstrated experience credentialing individual behavioral health providers and organizational/group entities
• Experience with CAQH and payer enrollment/credentialing systems
• Working knowledge of NPI, taxonomy, licensure verification, sanctions/exclusion screening, provider rosters, recredentialing, and payer enrollment documentation
• Experience tracking payer contracts, amendments, participation status, fee schedules, and renewal requirements preferred
• Strong proficiency with spreadsheets, document management, and electronic databases

Requirements

• Coordinate initial credentialing and recredentialing for CRHE providers
• Collect and verify licenses, certifications, education, work history, malpractice coverage, NPI information, CAQH data, and other required documentation
• Conduct or coordinate primary-source verification as required
• Monitor provider licenses and certifications and maintain expiration calendars
• Coordinate provider additions, terminations, demographic changes, and payer roster updates
• Credential CRHE organizational and group entities with applicable payers
• Maintain organizational NPI, taxonomy, ownership, location, accreditation/licensure, and tax documentation
• Coordinate group enrollment and linking of rendering providers to the appropriate group/entity and locations
• Maintain payer-specific group enrollment records and revalidation/recredentialing schedules
• Ensure organizational and provider information is consistent across payer systems
• Prepare and submit payer enrollment applications and supporting documentation
• Track enrollment status, effective dates, participation status, and payer correspondence
• Maintain payer contracts, amendments, fee schedules, participation agreements, and renewal dates
• Coordinate with leadership regarding payer contracting opportunities and documentation requests
• Maintain a centralized payer matrix showing CRHE entities, locations, providers, services, and participation status
• Monitor provider and organizational sanctions/exclusion requirements as assigned
• Track state license and credential requirements across operating jurisdictions
• Maintain audit-ready credentialing files
• Identify credentialing gaps that may delay billing or service delivery and escalate them promptly
• Support internal and external credentialing audits
• Develop and maintain credentialing trackers and dashboards
• Provide regular reports on pending enrollments, expirations, recredentialing, payer participation, and outstanding documentation
• Coordinate with HR, billing, clinical leadership, and operations regarding provider status
• Recommend process improvements to reduce credentialing and enrollment delays

Benefits

• 401(k)
• Dental insurance
• Opportunity for advancement
• Paid time off
• Training & development
• Vision insurance
• Wellness resources

Company Description

The Center for Research & Health Equity (CRHE) is an integrated behavioral healthcare organization committed to expanding equitable access to high-quality mental health, substance use disorder, and co-occurring disorder treatment for adults. Through interdisciplinary collaboration, culturally responsive care, evidence-based practice, and community partnerships, CRHE seeks to improve behavioral health outcomes while addressing the social and structural factors that influence health and recovery.

CRHE provides outpatient behavioral health services, intensive outpatient programming, partial hospitalization programming, psychiatric medication management, integrated care coordination, and community-based partnerships designed to improve long-term health, recovery, and quality of life.