Credentialing Specialist (Behavioral Health Practice Experience Required)

This role is responsible for credentialing, enrollment, and ongoing payor maintenance with the following plans:

Aetna, ASR Health Benefits, Blue Care Network (BCN), Blue Cross Blue Shield (BCBS), Federal Employees Health Benefits (FEHB), Medicare, MESSA, Optum, Oxford Health Plans, Priority Health, UnitedHealthcare, UM Health Plan, and Out-of-Network payors.

Credentialing & Enrollment Responsibilities

1. Manage the full credentialing lifecycle for Michigan-licensed behavioral health providers across all contracted and non-contracted payors.
2. Complete and submit initial and re-credentialing applications with Aetna, ASR, BCN, BCBS, FEHB, Medicare, MESSA, Optum, Oxford, Priority Health, UnitedHealthcare, and UM Health Plan.
3. Coordinate onboarding and re-credentialing for new and existing providers, including limited-license clinicians.
4. Track application status, respond to payor requests, and proactively follow up to prevent participation delays.
5. Maintain accurate provider credentialing files, including licenses, NPIs, DEA (when applicable), malpractice coverage, supervision documentation, and certifications.
6. Maintain and attest CAQH profiles for all applicable providers.
7. Monitor license, certification, and supervision expiration dates to ensure uninterrupted network participation.
8. Ensure provider demographic data, service locations, and telehealth designations are accurate with all payors.
9. Audit health plan directories regularly to ensure behavioral health provider accuracy and compliance.
10. Ensure the clinic maintains current copies of all payer fee schedules, reimbursement rates, and applicable behavioral health CPT/HCPCS codes.
11. Support out-of-network provider documentation and reimbursement workflows as needed.
12. Assist billing with credentialing-related claim denials, non-payment issues, and participation disputes.
13. Communicate credentialing status updates, risks, and timelines to leadership, intake, and billing teams.
14. Build and maintain professional working relationships with behavioral health payor representatives.
15. Ensure compliance with State of Michigan (LARA), CMS, and payor-specific credentialing requirements.
16. Maintain strict confidentiality of provider and patient information in accordance with HIPAA.


What You’ll Need to Be Successful

2+ years of provider credentialing experience in Michigan (behavioral health or medical office preferred)
Experience credentialing with:
BCBSM, BCN, Aetna, Optum/UnitedHealthcare, Medicare,Priority Health, PHP (Preferred)
2+ years of Verification of Benefits (VOB) experience
Credentialing software experience preferred
Google Workspace or Microsoft Office experience (1+ year)
HIPAA certification


Please fill out the form: ----------