Credentialing Specialist

Integrated Services for Behavioral Health; Cambridge (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

EAP

Job summary

Integrated Services for Behavioral Health (ISBH) seeks a Credentialing Specialist to manage provider credentialing and related billing operations, primarily focused on Medicaid in Ohio. The role requires maintaining CAQH, PECOS, NPPES, and CMS portals, with ongoing enrollment tasks and payer follow-up.

Qualifications include a high school diploma and preferably a bachelor's in accounting or credentialing, plus 1 year credentialing experience and relevant EHR familiarity.

Qualifications

• X years of credentialing experience in Ohio Medicaid (1 year minimum).
• Experience using electronic health record systems to process claims (3 years preferred).
• Knowledge of CAQH, PECOS, NPPES, CMS portals is preferred.

Responsibilities

• Maintain provider credentialing files and government/commercial payer portals.
• Track CAQH/PECOS/NPPES/CMS statuses and keep logins active.
• Enroll providers for NPI and terminate enrollment when needed.
• Coordinate credentialing, re-credentialing, and contracting with insurers.
• Communicate with managed care organizations and payers to follow up on credentialing stages.

Skills

Credentialing knowledge

Communication skills

Attention to detail

deadlines management

Education

High School Diploma or GED

Bachelor's degree in accounting or credentialing

Tools

CAQH

PECOS

NPPES

CMS portals

Job description

We are seeking a Credentialing Specialist!

Southeast, OH

Integrated Services for Behavioral Health (ISBH) is a community-minded, forward-thinking behavioral health organization helping people along the road to health and well-being. We meet people in their homes and communities and help connect them to the resources they need. We serve southeastern and central Ohio with a comprehensive array of behavioral health and other services – working with local partners to promote healthy people and strong communities. All our services are intended to be collaborative and personalized for the individual.

The Credentialing Specialist is responsible for processing supporting provider credentialing processes as well as conducting some client billing and other operations leading to reimbursement for behavioral health care and related services. The position is primarily focused on Medicaid, though it may work with Medicare and/or private payers.

The pay range for this position is $23.85 - $28.02 per hour based on experience, education, and/or licensure.

Essential Functions

• Maintain individual provider files to include up-to-date information needed to complete the required governmental and commercial payer credentialing applications.
• Maintain contracted Managed Care Organizations, commercial payers, CMS Medicare, Medicaid, PECOS, NPPES, and CAQH tracking log to ensure all necessary portals logins are active and available.
• Work with individual providers to ensure each provider's CAQH database files are updated in a timely manner according to the schedule published by CMS, Medicare/ Medicaid, and Managed Care Organizations regulations.
• Complete a new individual provider application for the National Provider Identifier (NPI).
• Terminating enrollment with government and commercial payers upon resignation or termination of providers.
• As directed, provide updated demographic information with supporting documents to outside participants, such as commercial managed care plans and contracted billing entities.
• Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases.
• Responsible for ensuring provider-collected information is current and accurate to ensure all individual providers are credentialed and recredentialed in a timely.
• Responsible for coordinating, monitoring, and maintaining the credentialing and re-credentialing process, re-credentialing, and contracting processes with insurance companies.
• Contacting Managed Care Organizations, Commercial plans, CMS Medicare, Medicaid and/or other insurance agencies to follow up on several stages in credentialing.
• Identifies potential onboarding issues or concerns; research provides clarification, and facilitates problem resolution.
• Attend internal and external trainings as needed.
• Other tasks as needed to support the Integrated Services Billing Department.

Education / Licensure

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

Experience

• 1 year of experience in credentialing in Ohio Behavioral Health Medicaid is required
• 3 years of experience using an electronic health record system to process claims is preferred

Knowledge, Skills, and Abilities

• A broad knowledge of community service systems is required
• Knowledge of electronic health record systems is required
• Excellent communication skills, both oral and written is required
• Excellent organizational skills are required
• A valid driver's license and the ability to operate a motor vehicle is required
• An appropriate level of auto insurance coverage is required
• Ability to manage deadlines within a fast-paced, high-volume environment is required
• The ability to operate in an Internet-based, automated office environment is required
• The ability to maintain a high-speed internet connection is required

Enjoy a great work environment with an excellent salary, generous paid time off, and a strong benefits package!

Benefits include

• Medical
• Dental
• Vision
• Short-term Disability
• Long-term Disability
• 401K w/ Employer Match
• Employee Assistance Program (EAP)

To learn more about our organization: https://integratedservices.org/

OUR VISION

Healthy people. Strong communities.

OUR MISSION

Delivering exceptional care through connection.

OUR VALUES

Dignity

We meet people where they are on their journey with respect and hope.

Collaboration

We listen to understand and ask how we can best support the people and communities we serve.

Wellbeing

We celebrate one another's strengths, and we support one another in being well.

Excellence

We demand high-quality care for those we serve and are a leader in how we care for one another as a team.

Innovation

We deeply value diversity of thought and experience, knowing it is what inspires us to stretch past where we are and reach towards what we know is possible.

The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this position. It is not to be construed as an exhaustive list of duties performed by the individuals in this role, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under their supervision.

We’re an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.