Credentialing & Billing Specialist (Medicaid)

Integrated Services for Behavioral Health; McArthur Township (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 in Southeast, OH seeks a Credentialing Specialist to manage provider credentialing files, CAQH, PECOS, NPPES, and CMS enrollment, with a focus on Medicaid.

This role also supports client billing and reimbursement workflows, updates demographics, terminates enrollments when needed, and coordinates recredentialing with insurance plans in a fast‑paced environment.

Qualifications

• A high school Diploma or GED equivalent is required
• A bachelor’s degree in accounting, credentialing, or a related field is preferred
• 1 year of credentialing experience in Ohio Behavioral Health Medicaid is required
• 3 years of experience using an electronic health record system to process claims is preferred

Responsibilities

• Maintain provider files with up-to-date information for credentialing applications
• Track CAQH, PECOS, NPPES, CMS portals and ensure logins are active
• Update CAQH, PECOS, NPPES profiles in a timely manner per CMS/regulations
• Complete NPI applications for new providers
• Terminate enrollments with payers when providers resign or are terminated
• Provide demographic updates to outside entities as needed
• Ensure provider profiles are current across databases
• Coordinate credentialing, recredentialing, and contracting with insurers
• Follow up with Managed Care Organizations and payers on credentialing steps
• Identify onboarding issues and facilitate problem resolution
• Attend trainings as needed
• Support Integrated Services Billing Department

Skills

Communication skills

Organizational skills

Time management

Attention to detail

Driver's license

Education

High school diploma or GED

Bachelor's degree in accounting or credentialing (preferred)

Tools

CAQH

PECOS

NPPES

CMS enrollment portals

Job description

Integrated Services for Behavioral Health in Southeast, OH seeks a Credentialing Specialist to manage provider credentialing files, CAQH, PECOS, NPPES, and CMS enrollment, with a focus on Medicaid.

This role also supports client billing and reimbursement workflows, updates demographics, terminates enrollments when needed, and coordinates recredentialing with insurance plans in a fast‑paced environment.