Mind Body Optimization Vision, Culture, and Pledge
At Mind Body Optimization, our vision is to create opportunities where healing is not just a destination but a sustainable, transformative process that fosters autonomy and ownership.
We cultivate a culture that embraces mental health with compassion, expertise, and confidence, empowering individuals to navigate their unique journey with resilience and unwavering support.
Together, we pledge to pave a path worth following, one where sustainable change is not only possible but achievable for all.
Position Summary
The Credentialing Specialist I plays a vital role in ensuring our clinical team meets regulatory, payer, and organizational standards. This position is responsible for the full lifecycle of provider credentialing and re-credentialing, managing payer enrollments, and maintaining compliance with federal, state, and payer-specific requirements.
Key Responsibilities
- Manage initial credentialing, re-credentialing, and privileging processes for behavioral health providers (psychiatrists, nurse practitioners, therapists, etc.).
- Coordinate payer enrollment, revalidation, and demographic updates with commercial insurers.
- Maintain up-to-date provider data in internal credentialing and EHR systems.
- Track and ensure timely renewal of licenses, certifications, DEA, malpractice insurance, and other credentials.
- Monitor and maintain compliance with NCQA, CMS, and state-specific standards.
- Respond to internal and external credentialing inquiries promptly and professionally.
- Collaborate with Human Resources, Clinical Leadership, and Billing/Revenue Cycle teams to ensure smooth onboarding and billing readiness for new hires.
- Prepare credentialing files for audits and participate in quality improvement initiatives.
Qualifications
- Associate’s or Bachelor’s degree in healthcare administration, business, or related field preferred.
- 2+ years of credentialing experience in a healthcare setting (behavioral health experience highly desirable).
- Working knowledge of CAQH, PECOS, NPPES, and payer portals.
- Familiarity with state/federal regulations, including Medicaid and Medicare guidelines.
- Strong attention to detail and excellent organizational skills.
- Proficient in Microsoft Office and credentialing software platforms.
- Ability to manage multiple priorities and meet deadlines.
- Excellent communication and collaboration skills.
Preferred Qualifications
- CPCS or CPMSM certification through NAMSS.
- Experience working in a multi-state behavioral health organization.
- Familiarity with EHRs and practice management systems.
