Credentialing Specialist

Integratedservice; Circleville (OH); On-site; USD 3,286,000 - 3,860,000; Full time

Job summary

Integrated Services for Behavioral Health (ISBH) in Ohio is seeking a Credentialing Specialist to manage provider credentialing and related billing operations. The role focuses on Medicaid and may involve Medicare or private payers.

It requires accuracy, communication, and strong organizational skills. The successful candidate will maintain provider files, oversee CAQH/NPPES/PECOS CMS portals, enroll and terminate enrollments, and support the Billing Department with timely credentialing

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 files for government and commercial credentialing.
• Track CAQH, PECOS, NPPES, CMS portals and ensure logins active.
• Update CAQH files per CMS, Medicare/Medicaid, and payer regulations.
• Enroll/terminate providers with government and commercial payers.
• Coordinate credentialing, re-credentialing and contracting with insurers.

Skills

Communication skills

Organizational skills

Time management

Driver's license

Internet access

Education

High school diploma

Bachelor's degree preferred

Tools

CAQH

PECOS

CMS portals

NPPES

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!

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.