Credentialing Specialist – Healthcare Access & Compliance

Integrated Services for Behavioral Health; Nelsonville (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 is seeking a Credentialing Specialist to support provider enrollment in government and commercial payers. The role maintains CAQH, PECOS, NPPES, and CMS records and ensures timely credentialing and re-credentialing.

The position requires experience with credentialing in Ohio Medicaid and familiarity with EHR systems. A valid driver's license and ability to work in Southeast Ohio are expected as part of field-based duties.

Qualifications

• 1 year of credentialing experience in Ohio Behavioral Health Medicaid is required.
• Experience with electronic health record systems to process claims is preferred.
• Knowledge of CAQH, PECOS, NPPES, and CMS databases is preferred.
• Excellent communication, organizational, and time-management skills are required.

Responsibilities

• Maintain individual provider files with up-to-date information for credentialing applications.
• Track CAQH, PECOS, NPPES, and CMS portals to ensure logins are active.
• Update CAQH database files for providers according to CMS and payer schedules.
• Process new NPI applications for providers.
• Handle enrollment terminations with government and commercial payers.
• Provide updated demographics to outside participants as needed.
• Maintain provider profiles on CAQH, PECOS, NPPES, and CMS databases.
• Coordinate credentialing and re-credentialing with insurance plans.
• Follow up with payers on credentialing stages.
• Identify onboarding issues and facilitate resolutions.
• Attend trainings and support Billing Department.

Skills

Credentialing

CAQH

PECOS

NPPES

CMS Medicare/Medicaid

Communication skills

Organizational skills

Driver's license

Auto insurance

High-volume environment

Education

Bachelor's degree in accounting, credentialing, or related field

High school Diploma or GED

Tools

EHR systems

CAQH portal

PECOS portal

NPPES portal

Job description

Integrated Services for Behavioral Health is seeking a Credentialing Specialist to support provider enrollment in government and commercial payers. The role maintains CAQH, PECOS, NPPES, and CMS records and ensures timely credentialing and re-credentialing.

The position requires experience with credentialing in Ohio Medicaid and familiarity with EHR systems. A valid driver's license and ability to work in Southeast Ohio are expected as part of field-based duties.