Behavioral Health Credentialing Specialist

Integrated Services for Behavioral Health; Nelsonville (OH); On-site; USD 33,000 - 39,000; Full time

Benefits offered by this job

Medical

Dental

Vision

Short-term Disability

Long-term Disability

401K w/ Employer Match

Employee Assistance Program (EAP)

Job summary

Integrated Services for Behavioral Health is seeking a Credentialing Specialist to manage provider credentialing and related client billing activities. The role focuses on Medicaid and may involve Medicare and private payers.

The position is located in Southeast, OH, with a pay range of $23.85 - $28.02 per hour based on experience, education, and licensure. Essential duties include maintaining provider files, handling CAQH/NPPES/CMS portals, updating NPI applications, and coordinating

Qualifications

• A high school Diploma or GED equivalent is required.
• A bachelor’s degree in accounting, credentialing, or a related field is preferred.

Responsibilities

• Maintain provider files with updated information for credentialing applications.
• Track CAQH, PECOS, NPPES, CMS portals and ensure logins are active.
• Update provider CAQH files per CMS/Medicare regulations.
• Complete new provider NPI applications.
• Terminate enrollments when providers resign or are terminated.
• Provide updated demographic information to external plans and billing entities.
• Maintain provider profiles on CAQH, PECOS, NPPES, CMS databases.
• Ensure provider information is current for credentialing and recredentialing.
• Coordinate credentialing, re-credentialing, and contracting with insurers.
• Follow up with Managed Care Organizations and CMS/Medicare on credentialing stages.
• Identify onboarding issues and coordinate resolutions.
• Attend trainings and support Billing Department.

Skills

Excellent communication

Excellent organizational

Deadline management

Internet-based office software

Driver's license

Auto insurance awareness

Education

High school diploma or GED

Bachelor’s degree in accounting/credentialing or related field

Tools

Electronic Health Record (EHR) systems

Job description

Integrated Services for Behavioral Health is seeking a Credentialing Specialist to manage provider credentialing and related client billing activities. The role focuses on Medicaid and may involve Medicare and private payers.

The position is located in Southeast, OH, with a pay range of $23.85 - $28.02 per hour based on experience, education, and licensure. Essential duties include maintaining provider files, handling CAQH/NPPES/CMS portals, updating NPI applications, and coordinating