Credentialing and Compliance Specialist

Credentialing & Compliance Specialist

Full time/Exempt

Location: Cherry Hill, NJ

Compensation Range: $60,000 - $70,000 annually

Reports to: Director of Human Resources

Position Summary:

The Credentialing & Compliance Specialist is a hands-on, detail-oriented role responsible for handling insurance credentialing and proactively managing organizational compliance across clinical, operational, and regulatory domains. This includes credentialing, incident reporting, internal audits, licensing readiness, and more. This role is essential in ensuring our services meet state (DOE, DCF, PA IBHS), federal (FERPA, HIPAA), and insurance credentialing standards, with a special focus on audit readiness and quality assurance.

This role is ideal for someone who thrives in a fast-paced, mission-driven environment, can manage complex regulatory workflows, and is comfortable navigating between clinical, HR, and administrative teams.

Job Responsibilities:

Credentialing & Roster Maintenance

• Manage initial and ongoing credentialing via CAQH, Availity, and insurance portals; maintain clinician rosters, CANS certifications, and attestations per payer requirements.
• Collaborate with the Revenue Cycle team on credentialing crossovers as needed.

Regulatory & Internal Audits

• Conduct internal audits of clinical, employee, and billing documentation; lead preparation and submission for DOE, IBHS, licensing, and insurance audits.
• Coordinate and facilitate quarterly IBHS mock audits across sites

Incident Management & Reporting

• Monitor, triage, and investigate incident reports (with HR support); ensure timely updates in SharePoint and Central Reach.
• Maintain incident tracking systems, archive reports, and lead monthly cross-functional incident review meetings.

Onboarding & Orientation

• Review new hire documentation for compliance.
• Lead the Compliance training portion of orientation (both virtual and in-person).
• Maintain compliance documentation, training certificates, and retraining schedules for all employees.

Special Projects & Ongoing Support

• Lead compliance-related projects (quality improvement, policy updates, credentialing initiatives) and support Workers’ Comp reporting and HR file audits.
• Provide cross-functional compliance support, travel between NJ/PA as needed, and perform other duties as assigned.

Team:

This role will be part of the Human Resources team reporting to the Director of Human Resources, working closely with Operations and Revenue Cycle teams.

Basic Qualifications:

• 3–5 years of experience in insurance, healthcare, behavioral health, or education compliance or operations.
• Experience with credentialing and provider enrollment systems (CAQH, Availity).
• Strong proficiency in Microsoft Excel, SharePoint, and data systems (e.g., ADP, Central Reach).
• Excellent communication, follow-through, and organizational skills.
• Ability to handle sensitive incidents with discretion, timeliness, and professionalism.

Preferred Qualifications:

• Working knowledge of FERPA, HIPAA, DOE, and/or IBHS requirements strongly preferred.
• An associate's degree or higher is preferred.

Benefits:

Our benefit package includes medical, dental, and vision plans, vacation/sick pay, life insurance, short & long-term disability, access to EAP and discount plans, 401(k) retirement plan, and employee referral bonus plan.

Who we are:

First Children Services is comprised of a dedicated team of professionals committed to providing the very best services day in and day out. We integrate a variety of effective techniques along with family involvement to achieve optimum results. At First Children Services, children and their families with the most extraordinary challenges are met with compassion, dedication and determination.

EEO: First Children Services is an equal opportunity employer and provider. Our agency prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

First Children Services is committed to being an Equal Employment Opportunity (EEO) Employer and offers opportunities to all job seekers including individuals with disabilities. If you need a reasonable accommodation to assist with your job search or application for employment, email us at [email protected]. In your email, please include a description of the specific accommodation you are requesting as well as the job title and requisition ID number of the position for which you are applying.