Credentialing Specialist — Healthcare Billing & Compliance

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

Job summary

Integrated Services for Behavioral Health (ISBH) is a community-minded behavioral health organization serving Southeast and Central Ohio. The Credentialing Specialist role focuses on processing provider credentialing and related payer activities to ensure timely reimbursement for behavioral health services.

Primary responsibilities include CAQH/NPPES/PECOS management, NPI applications, and enrollment terminations. Medicaid experience is required, with EHR claims processing experience preferred.

Qualifications

• High school diploma or GED required.
• Bachelor's degree in accounting or credentialing preferred.
• 1 year credentialing experience in Ohio Behavioral Health Medicaid required.
• 3 years of experience with an electronic health record system to process claims preferred.

Responsibilities

• Maintain individual provider files with up-to-date information for credentialing applications.
• Track CAQH, PECOS, NPPES, CMS portals and payer logins.
• Update CAQH files with CMS/Medicare/Medicaid schedules.
• Complete new provider NPI applications.
• Terminate enrollments with government and commercial payers when needed.
• Provide updated demographic information to plans and billing entities.
• Maintain provider profiles in CAQH, PECOS, NPPES, CMS databases.
• Coordinate credentialing, re-credentialing, and contracting with insurers.
• Follow up with plans to resolve credentialing stages.
• Identify onboarding issues and facilitate resolution.
• Attend trainings and support IS billing department.

Skills

Community service systems

Electronic health record systems

Excellent communication skills

Excellent organizational skills

Driver's license

Auto insurance

Deadline management

Internet-based office tools

Education

High school diploma or GED

Bachelor's degree preferred in accounting/credentialing/related field

Job description

Integrated Services for Behavioral Health (ISBH) is a community-minded behavioral health organization serving Southeast and Central Ohio. The Credentialing Specialist role focuses on processing provider credentialing and related payer activities to ensure timely reimbursement for behavioral health services.

Primary responsibilities include CAQH/NPPES/PECOS management, NPI applications, and enrollment terminations. Medicaid experience is required, with EHR claims processing experience preferred.