Overview

Company Summary

If you are searching for a fulfilling place to develop your career and an opportunity to make a difference in helping others, then keep reading on. Here at AAC, we have a progressive culture; we listen to your ideas, value a work/life balance, invest in education, and we foster trust and respect for all individuals. Our exceptional comp and strong benefits include company matching 401K, medical, dental, vision and life insurance. We are looking for our future leaders, who are not only going to fill the qualifications for this job description, but who are going to exceed expectations. Be a part of a team whose mission is to provide quality, compassionate, and innovative care to adults struggling with addiction and co-occurring mental health disorders. Our purpose and passion are to empower patients, their families, and our communities by helping individuals achieve recovery and optimal wellness of the mind, body, and spirit.

Responsibilities

Job Summary:

The Credentialing & Provider Enrollment Specialist is responsible for the ongoing lifecycle management of provider and facility credentialing for American Addiction Centers (AAC). This includes payer enrollment, continuous monitoring, re-credentialing, compliance audits, and timely de-enrollment. The role ensures all providers remain qualified, approved, and maintained in good standing with regulatory bodies, accrediting organizations, and payers after initial hire. The function partners closely with HR, Compliance, and RCM to maintain accurate data, minimize billing risk, and ensure all providers remain cleared to practice and submit claims to third-party payers.

Key Responsibilities:

Provider Credentialing Lifecycle Management (Post-Hire)

• Maintain complete, secure credentialing files for active providers following HR-led onboarding and initial credentialing
• Review credentialing documentation transferred from HR for completeness, structure, and audit readiness prior to payer submission or ongoing monitoring
• Maintain standardized file organization, documentation discipline, and credentialing records to support internal review and external audit requirements
• Coordinate with HR and facility leadership to ensure credentialing records remain current throughout the provider lifecycle
• Develop and maintain role-specific training materials, SOPs, and standardized documentation that support consistent credentialing and provider enrollment workflows across markets

Payer Enrollment and Network Maintenance

• Manage payer applications, submissions, and follow-ups for commercial, Medicare, and Medicaid plans for active providers; ensure timeliness of enrollments, revalidations, and payer-required recredentialing cycles to prevent revenue delays and billing interruptions
• Maintain and update provider demographics, taxonomy, and location data in payer portals and systems of record, including the NPI Registry (NPPES), to keep published provider data accurate for enrollment and directory use
• Maintain CAQH profiles for all providers, including re-attestation every 120 days and as otherwise required, and coordinate provider outreach and document collection to prevent CAQH profile inactivation
• Oversee delegated credentialing rosters per payor requirements, ensuring accurate and on-time submissions
• Coordinate resolution of credentialing or enrollment denials, ensuring providers remain billable and compliant; investigate payer discrepancies and support root-cause correction to reduce credentialing-related A/R holds
• Communicate credentialing and enrollment status updates to RCM, billing, and operations teams
• Maintain accuracy of PECOS enrollment records for Medicare-related enrollment and revalidation activity, tracking due dates and submission status to protect Medicare billing privileges
• Manage payer enrollment systems and ensure accurate, timely reporting, including provider activation status, enrollment aging, and key exception categories for leadership visibility

License, Sanction Monitoring, and Recredentialing [collaboration with TA team]

• Administer continuous monitoring using ProviderTrust (Passport) or similar system for licenses, DEA/CSR, exclusions, and sanctions; investigate and resolve alerts within established timeframes, documenting resolution and disposition in the provider's credentialing file
• Route automated monitoring alerts to designated TA Team, HR, applicable facility leadership, and Compliance distribution lists to ensure timely review, escalation, and closure without reliance on single-person routing
• Perform NPDB re-queries and license verifications as required annually per hire date and/or per when the initial NPDB check was run; maintain NPDB scheduling visibility and proactive work queues for upcoming re-queries
• Perform monthly OIG LEIE and SAM.gov exclusion screening for providers and licensed professionals as an ongoing monitoring control aligned to monthly source updates, investigating potential matches, and retaining evidence of resolution
• For providers engaged as 1099, obtain, review, and store required documents in a centralized repository for reference or renewal at a later date; coordinate with Legal, HR, and RCM as needed
• Ensure audit-ready credentialing records with full documentation and activity logs, using standardized file structure, storage, and internal communications pathways

Compliance, Audit, and Lifecycle Management [collaboration with Compliance team]

• Develop, maintain, and update credentialing policies and procedures in accordance with Joint Commission, CMS, NCQA, payer, and state requirements, including documentation standards and credentialing decision support artifacts
• Conduct internal file audits and quality checks; document findings and implement corrective actions, including targeted retraining and SOP updates where patterns recur
• Support external payor, accreditor, or regulatory audits; compile and provide documentation, respond to inquiries, and remediate deficiencies, with Compliance directing audit coordination and triage across HR and TA Team partners
• Collaborate with Compliance to ensure adherence to organizational standards and risk mitigation strategies
• Provide training and guidance to HR, RCM, and operations leadership regarding credentialing processes, monitoring requirements, and regulatory updates

Provider De-Enrollment and Offboarding

• Manage payer de-enrollment processes for providers separating from AAC, ensuring prompt removal from payer rosters, directories, and billing systems
• Obtain an HR-sourced provider departure list and reconcile it against active provider rosters on a monthly cadence, including provider credentials required for roster and directory accuracy
• Communicate termination effective dates to RCM and billing to prevent claim submission under inactive NPIs
• Archive credentialing files according to retention policy; ensure completion of all documentation and closeout actions
• Report de-enrollment completions and metrics to RCM and Compliance leadership

Other Responsibilities

• Develop and foster a positive, professional, team-oriented, harassment-free work environment by understanding and complying with company policies
• Demonstrate ethical conduct, professional judgment, confidentiality, and stewardship in all credentialing activities, financial reporting, and interactions with providers and payer representatives
• Perform other duties as assigned

Qualifications

Education and Certifications

• Bachelor's Degree (or higher) in Healthcare Administration, Business, or a related field, or equivalent combination of education and experience
• Master's Degree preferred

Experience

• Minimum of 3 years of progressive healthcare credentialing and provider enrollment experience; behavioral health experience strongly preferred
• Demonstrated knowledge of Joint Commission, CMS, NCQA, and payer credentialing standards, including recredentialing and audit-ready documentation expectations
• Experience using NPDB, ProviderTrust (Passport), CAQH, NPPES, PECOS, and payer enrollment portals
• Strong background in regulatory compliance, data management, and audit preparation, including internal quality checks and corrective action workflows
• Demonstrated ability to develop training materials, SOPs, and workflow documentation; mentor new specialists; and implement tracking that improves turnaround time for provider enrollment and recredentialing activity

Personal Attributes

• Meticulous attention to detail and personal drive to lead and implement process improvements
• Expert understanding of credentialing lifecycle management, recredentialing, and payer enrollment processes
• Knowledge of accreditation, licensure, and exclusion monitoring requirements
• High level of accuracy, organization, and documentation discipline
• Proficiency in Microsoft Excel, credentialing software, and database tools
• Ability to manage multiple priorities, meet deadlines, and maintain confidentiality
• Excellent communication and collaboration skills across departments and with external payers

Other Work Requirements

• Travel Percentage: <10%
• Expected hours of work: Full-Time Monday-Friday

Physical Requirements

AAC is committed to principles of equal opportunities for all employees. The Company will provide reasonable accommodations that are necessary to comply with State and Federal disability discrimination laws.

• Prolonged sitting at a desk
• Must be able to lift 15 pounds at a time

American Addiction Centers is an equal opportunity employer. American Addiction Centers prohibit employment practices that discriminate against individuals or groups of employees based on age, color disability, national origin, race, religion, sex, sexual orientation, pregnancy, veteran or military status, genetic information or any other category deemed protected by state and/or federal law.