Credentialing Specialist

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

Job summary

Integrated Services for Behavioral Health (ISBH) in Southeast, OH is seeking a Credentialing Specialist to manage provider credentialing and related billing operations. The role focuses on Medicaid enrollment and coordination with other payers.

You will maintain provider profiles in CAQH, PECOS, NPPES, and CMS databases, enroll providers for NPI, and support the Billing Department to ensure timely reimbursement.

Qualifications

• 1 year credentialing experience in Ohio Medicaid required.
• 3 years using an electronic health record system to process claims preferred.
• Excellent communication and organizational skills.
• Valid driver’s license and auto insurance required.
• Bachelor’s degree preferred in accounting/credentialing or related field.
• Ability to work in a fast-paced environment and meet deadlines.

Responsibilities

• Maintain provider files and credentialing applications.
• Track CAQH, PECOS, NPPES, CMS portals and logins.
• Update CAQH files with CMS/Medicaid schedules.
• Enroll providers for National Provider Identifier (NPI).
• Terminate enrollments when providers resign or terminate.
• Coordinate credentialing, re-credentialing, and contracting with insurers.
• Communicate with payers to follow up on credentialing stages.
• Assist Billing Department as needed.

Skills

CAQH tracking

NPI enrollment

CMS/Medicaid knowledge

EHR experience

Communication

Time management

Education

High school diploma or GED

Bachelor’s degree preferred

Tools

CAQH

PECOS

NPPES

CMS databases

EHR system

Job description

Career Opportunities with Integrated Services for Behavioral Health

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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.