Credentialing Specialist - Behavioral Health Payer Onboarding

Integrated Services for Behavioral Health; Athens (OH); On-site; USD 50,000 - 58,000; 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 seeking a Credentialing Specialist to manage provider credentialing and enrollment processes across government and commercial payers in Southeast Ohio. The role requires handling CAQH, PECOS, NPPES, and CMS databases, updating provider records, and coordinating re-credentialing and contracting with insurers.

The ideal candidate will have 1 year of Ohio Medicaid credentialing experience, strong organization and communication skills, and a valid

Qualifications

• High school Diploma or GED required
• Bachelor’s degree preferred in accounting, credentialing, or related field
• 1 year credentialing in Ohio Behavioral Health Medicaid required
• 3 years experience using an electronic health record (EHR) system to process claims preferred

Responsibilities

• Maintain provider files for credentialing applications
• Track CAQH, PECOS, NPPES and CMS portals and ensure logins are active
• Update CAQH database files per CMS/Medicaid regulations
• Complete NPI applications for new providers
• Terminate enrollment with payers upon provider resignation/termination
• Provide updated demographic information to outside participants
• Maintain provider profiles on CAQH, PECOS, NPPES and CMS databases
• Ensure provider information is current for credentialing/re-credentialing
• Coordinate credentialing, re-credentialing, and contracting with insurers
• Follow up with MCOS, CMS, Medicaid and other insurers on credentialing stages
• Identify onboarding issues and facilitate problem resolution
• Attend internal/external trainings
• Support Integrated Services Billing Department with additional tasks

Skills

Excellent communication

Excellent organizational skills

Deadline management

Driver's license

Detail-oriented

Education

High school Diploma or GED

Bachelor's degree in accounting/credentialing/related field

Tools

CAQH

PECOS

NPPES

CMS portals

Job description

Integrated Services for Behavioral Health (ISBH) is seeking a Credentialing Specialist to manage provider credentialing and enrollment processes across government and commercial payers in Southeast Ohio. The role requires handling CAQH, PECOS, NPPES, and CMS databases, updating provider records, and coordinating re-credentialing and contracting with insurers.

The ideal candidate will have 1 year of Ohio Medicaid credentialing experience, strong organization and communication skills, and a valid