Credentialing Specialist - Behavioral Health Payer Liaison

Integrated Services for Behavioral Health; Zanesville (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

Employee Assistance Program (EAP)

Job summary

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.

Responsibilities

• 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.

Skills

Attention to detail

Communication skills

Time management

Driver's license

Internet-based systems

Education

High school diploma or GED

Bachelor's degree preferred in accounting/credentialing

Tools

CAQH

PECOS

NPPES

CMS

EHR system

Job description

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.