Credentialing & Reimbursement Specialist - Behavioral Health

Integratedservice; Ashville (OH); On-site; USD 33,000 - 39,000; Full time

Job summary

Integrated Services for Behavioral Health in Ohio is seeking a Credentialing Specialist to manage provider credentialing processes and related payer enrollment, primarily focusing on Medicaid.

The role includes maintaining CAQH/NPPES/PECOS tracking, coordinating with providers and payers, and supporting billing operations to ensure timely reimbursement. Strong organizational and communication skills are essential.

Qualifications

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

Responsibilities

• Maintain provider credentialing files with up-to-date information for governmental and commercial payer applications.
• Track CAQH, PECOS, NPPES, and CMS portal logins to ensure access is active.
• Update provider CAQH files timely per CMS/Medicaid regulations.
• Enroll new providers in National Provider Identifier (NPI).
• Terminate enrollments with government and commercial payers when providers resign or are terminated.
• Coordinate updated demographic information with outside participants.

Skills

Credentialing

Medicaid knowledge

Communication skills

Organization

Driver's license

Education

High school diploma or GED

Bachelor's degree in accounting/credentialing

Tools

EHR systems

CAQH

PECOS

NPPES

CMS portals

Job description

Integrated Services for Behavioral Health in Ohio is seeking a Credentialing Specialist to manage provider credentialing processes and related payer enrollment, primarily focusing on Medicaid.

The role includes maintaining CAQH/NPPES/PECOS tracking, coordinating with providers and payers, and supporting billing operations to ensure timely reimbursement. Strong organizational and communication skills are essential.