Credentialing & Billing Specialist (Medicaid Focus)

Integrated Services for Behavioral Health; Portsmouth (OH); On-site; USD 50,000 - 58,000; Full time

Benefits offered by this job

Medical

Dental

Vision

Short-term Disability

Long-term Disability

401K with Employer Match

Employee Assistance Program (EAP)

Job summary

Integrated Services for Behavioral Health is seeking a Credentialing Specialist to manage provider credentialing and related billing operations. Primary focus is Medicaid, with potential work for Medicare and private payers.

The role emphasizes maintaining provider profiles in CAQH, PECOS, NPPES, and CMS databases, enrolling and terminating with payers, and ensuring timely credentialing processes in a fast-paced environment. Experience in Ohio Medicaid credentialing is required.

Qualifications

• High school Diploma or GED required.
• Bachelor’s degree in accounting, credentialing, or related field preferred.
• 1 year credentialing experience in Ohio Behavioral Health Medicaid required.
• 3 years experience using an electronic health record system to process claims preferred.

Responsibilities

• Maintain provider files and required payer credentialing applications.
• Track CAQH, PECOS, NPPES, and CMS portal logins and activity.
• Update CAQH database files for providers per CMS timelines.
• Complete new NPI applications for providers.
• Terminate enrollments with government and commercial payers when needed.
• Coordinate credentialing, re-credentialing, and contracting with insurers.

Skills

Credentialing

CAQH

CMS portals

NPPES

Communication

Time management

Education

High school diploma

Bachelor’s degree preferred

Tools

EHR systems

PECOS

NPPES

CAQH

CMS databases

Job description

Integrated Services for Behavioral Health is seeking a Credentialing Specialist to manage provider credentialing and related billing operations. Primary focus is Medicaid, with potential work for Medicare and private payers.

The role emphasizes maintaining provider profiles in CAQH, PECOS, NPPES, and CMS databases, enrolling and terminating with payers, and ensuring timely credentialing processes in a fast-paced environment. Experience in Ohio Medicaid credentialing is required.