Credentialing Specialist: Medicaid & Payer Credentialing

Integratedservice; Columbus (OH); On-site; USD 50,000 - 58,000; Full time

Benefits offered by this job

Great work environment

Generous paid time off

Strong benefits package

Job summary

Integrated Services for Behavioral Health (ISBH) is seeking a Credentialing Specialist to manage provider credentialing and related billing operations in Southeast Ohio. The role emphasizes Medicaid, with potential Medicare or private payer work, and involves maintaining portals like CAQH, PECOS, and CMS systems.

Responsibilities include processing credentialing applications, updating provider records, and coordinating re-credentialing and contracting with insurers.

Qualifications

• High school diploma or GED required.
• Bachelor's degree in accounting, credentialing, or related field preferred.

Responsibilities

• Maintain provider credentialing files and required payer applications.
• Track CAQH, PECOS, NPPES, and CMS portals and logins.
• Update CAQH files for providers per CMS/Medicare regulations.
• Process NPI applications for providers.
• Terminate enrollments when providers resign or are terminated.
• Coordinate credentialing and re-credentialing with insurers.

Skills

Communication

Organizational skills

Driver's license

Auto insurance

Deadline management

Internet-based systems

Education

High school diploma or GED

Bachelor's degree preferred

Tools

EHR systems

Job description

Integrated Services for Behavioral Health (ISBH) is seeking a Credentialing Specialist to manage provider credentialing and related billing operations in Southeast Ohio. The role emphasizes Medicaid, with potential Medicare or private payer work, and involves maintaining portals like CAQH, PECOS, and CMS systems.

Responsibilities include processing credentialing applications, updating provider records, and coordinating re-credentialing and contracting with insurers.