Credentialing Specialist, US
Own every credentialing application for your clients, negotiate the payer contracts behind them, and be the person those clients call. A provider who cannot bill is a client about to leave. This seat stops both.
The role
What this job actually is
Credentialing is where revenue starts, and where clients quietly start to leave. A provider waiting on enrollment cannot bill, a lapsed CAQH attestation stops claims, and a fee schedule nobody has challenged in four years costs a practice money every single visit. In this role you own all of it for your clients: the application, the payer, the contract and the relationship. You serve ABA agencies, mental health practices, hospitals and FQHCs. This is not a forms desk. In the same week you will fill and file applications yourself, review and guide the work of our credentialing team, negotiate rates with a payer, and sit with a practice owner who is frustrated. You switch to whatever the client needs that day. You are the face of ASP-RCM to the client, and the client is your responsibility: if a client leaves because something was missed, that is on this seat.
Ownership
What you will own
Every credentialing application, end to end
Initial enrollment, re-credentialing and revalidation for groups and individual providers across commercial, Medicare, Medicaid and managed care plans. Complete and correct the first time, because incomplete files are the main cause of delay.
Payer forms, portals and profiles
CMS-855 forms and PECOS, NPPES, CAQH ProView kept current and re-attested every 120 days, state Medicaid enrollment portals, managed care applications, payer rosters and delegated credentialing files.
Payer contract negotiation
Benchmark fee schedules against Medicare and market rates, request rate increases at renewal, negotiate single case agreements, push closed panels to open, and win retroactive effective dates. You walk into every payer call with the numbers.
Specialty depth that clients trust
ABA: BCBA, BCaBA and RBT requirements by payer and state Medicaid program. Mental health: psychologists, LCSWs, LPCs and LMFTs, including Medicare enrollment for marriage and family therapists and mental health counselors. Hospitals: facility enrollment, delegated agreements and privileging. FQHCs: HRSA credentialing and privileging, Medicare and Medicaid managed care enrollment.
The client relationship
You are the face of ASP-RCM to practice owners, administrators and CFOs. Weekly status in plain language: what was filed, what is pending, what it is worth, and what happens next. No client should ever have to chase us.
Client retention, nothing missed
Churn on your accounts is your responsibility. You know first when a client is unhappy, you fix the cause, and you escalate early. No client leaves because a step was skipped.
Transaction-level command
Where every application sits, every payer effective date, which claims are on hold waiting for enrollment, and the dollars at stake. You work with billing so held claims go out the day a provider is effective.
Expirables and recredentialing
Licenses, DEA, board certifications, malpractice, CAQH attestations, Medicare revalidation every five years and payer recredentialing, usually every 36 months. Started early, tracked daily. Nothing lapses.
Supervising the work
Guide and review the credentialing coordinators who support your clients, set the follow-up cadence, and step in to do the work yourself whenever it matters. Doer and supervisor, both.
Ramp
Your first 90 days
First 30 days
Learn every client on your book: the provider-by-payer status, open applications, contract terms, fee schedules and renewal dates. Meet each client and make sure they know your name.
By day 60
A follow-up cadence running on every open application, an expirables calendar with nothing unknown, a weekly client status in place, and your first fee schedule review with a comparison the client can act on.
By day 90
Zero surprise lapses, aged applications cleared or escalated with a plan, at least one rate increase, single case agreement or retro effective date won, and every client on your book calling you first.
Requirements
What we look for
- Hands-on experience owning payer credentialing and enrollment for US healthcare providers, from application to effective date
- Fluent in CMS-855 forms and PECOS, NPPES, CAQH ProView, state Medicaid enrollment and managed care applications
- Experience negotiating payer contracts or rates, including single case agreements, with outcomes you can walk us through
- Working knowledge of at least two of our specialties: ABA, mental health, hospitals and FQHCs
- Client-facing experience: you have been the person a practice owner or administrator calls, and you kept the account
- You understand the money behind credentialing: held claims, retro effective dates, timely filing and denials for providers who are not enrolled
- Able to lead and review the work of others and also do it yourself, working with a team across time zones
- Organised and disciplined: every application, date and follow-up logged the same day
- Based in the United States
Bonus
Strong plus, not required
- CPCS or CPMSM certification
- Delegated credentialing and NCQA credentialing standards
- HRSA credentialing and privileging for health centers
- State Medicaid ABA program requirements, or behavioral health managed care networks
- Payer contract analysis in a spreadsheet: fee schedule modelling, rate comparisons, renewal planning
Read this first
This job is several jobs. Here is why.
- Some days you fill and file forms. Some days you negotiate rates. Some days you sit with an unhappy client. You switch as the day needs.
- Payers are slow. Follow-up is the job: you chase until there is an effective date, in writing.
- Client retention on your accounts is your responsibility, and we will review it with you openly.
- One missed expirable can stop a provider from billing. Nothing gets missed.
Accountability
How this role is measured
| Measure | What it means |
|---|---|
| Client retention | No client on your book lost to a missed step. The core measure of the role. |
| Time to enrollment | Submission to effective date, by payer, tracked for every application. |
| First-pass acceptance | Applications accepted without being returned for missing information. |
| Lapses | Zero expired credentials, attestations or missed revalidations. |
| Contract outcomes | Rate increases, single case agreements and retro effective dates won. |
| Client communication | Weekly status delivered and every client issue closed with a root cause. |
Why ASP-RCM
Why this seat is different
We are senior-led by design. A senior partner is named on accounts and shows up in the work, which is why clients renew and why this role carries real authority rather than a title. Our AI suite is in production, not in a roadmap deck, and our compliance posture is independently audited: SOC 2 Type II with HITRUST, ISO 27001 and HIPAA.
We pay for certifications and run upskilling cohorts. You will work across Frisco, TX HQ, six US states and Chennai, India, with colleagues who have run these functions at scale.
Apply
Apply for this role
Takes two minutes, works on any device. A senior partner reads every application. Prefer email? Write to [email protected] with “Credentialing Specialist, US” in the subject line.