Credentialing Specialist

Integrated Services for Behavioral Health; Zanesville (OH); Sur place; USD 33 000 - 39 000; Plein temps

Avantages offerts par ce poste

Medical

Dental

Vision

Short-term Disability

Long-term Disability

401K w/ Employer Match

Employee Assistance Program (EAP)

Résumé du poste

Integrated Services for Behavioral Health (ISBH) is a community-focused behavioral health organization serving Southeast and Central Ohio. We seek a Credentialing Specialist to manage CAQH, PECOS, NPPES, and CMS databases, ensuring timely credentialing and recredentialing for providers.

The role involves maintaining provider profiles, coordinating with payers, and updating demographic information as required.

Qualifications

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

Responsabilités

• Maintain individual provider files to include up-to-date information needed to complete required governmental and commercial payer credentialing applications.
• Maintain contracted Managed Care Organizations, commercial payers, CMS Medicare, Medicaid, PECOS, NPPES, and CAQH tracking logs to ensure portals logins are active.
• Work with individual providers to ensure CAQH database files are updated on schedule.
• Complete a new provider application for the National Provider Identifier (NPI).
• Terminate enrollment with government and commercial payers upon resignation or termination of providers.
• 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.
• Ensure provider-collected information is current to credential and recredential providers in a timely manner.
• Coordinate, monitor, and maintain credentialing, re-credentialing, and contracting processes with insurance companies.
• Contact Managed Care Organizations and CMS for credentialing follow-ups.
• Identify onboarding issues; research and resolve as needed.
• Attend internal and external trainings as needed.
• Support the Integrated Services Billing Department with other tasks.

Connaissances

Attention to detail

Communication skills

Time management

Driver's license

Internet-based systems

Formation

High school diploma or GED

Bachelor's degree preferred in accounting/credentialing

Outils

CAQH

PECOS

NPPES

CMS

EHR system

Description du poste

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 Southeast 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 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.

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.