Credentialing Specialist – Behavioral Health & Billing

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

Job summary

Integrated Services for Behavioral Health (ISBH) is seeking a Credentialing Specialist in Southeast Ohio. The role concentrates on processing provider credentialing and related activities to support reimbursement for behavioral health services.

The position primarily handles Medicaid credentialing, with possible work on Medicare and other payer enrollments. The pay range is $23.85-$28.02 per hour, based on experience and licensure.

Qualifications

• High school diploma or GED required; bachelor’s degree in accounting, credentialing, or a related field preferred.
• 1 year credentialing experience in Ohio Behavioral Health Medicaid is required
• Experience with electronic health record systems for claims processing is preferred
• Knowledge of CAQH, PECOS, NPPES, and CMS portals is desirable
• Excellent communication and organizational skills; valid driver's license and auto insurance

Responsibilities

• Maintain individual provider files with up-to-date information for governmental and commercial payer credentialing applications.
• Maintain tracking logs for Managed Care Organizations, commercial payers, CMS Medicare/Medicaid, PECOS, NPPES, and CAQH.
• Update CAQH, PECOS, NPPES, and CMS provider profiles timely.
• Complete NPI applications for providers.
• Terminate enrollments when providers resign or are terminated.
• Coordinate, monitor, and maintain credentialing and re-credentialing processes with insurers.
• Follow up with insurance agencies on credentialing stages.
• Attend trainings as needed and support ISBH Billing Department.

Job description

Integrated Services for Behavioral Health (ISBH) is seeking a Credentialing Specialist in Southeast Ohio. The role concentrates on processing provider credentialing and related activities to support reimbursement for behavioral health services.

The position primarily handles Medicaid credentialing, with possible work on Medicare and other payer enrollments. The pay range is $23.85-$28.02 per hour, based on experience and licensure.