Credentialing Specialist – Behavioral Health & Reimbursement

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

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.