Credentialing Specialist - Medicaid & Payer Enrollments

Integrated Services for Behavioral Health; Gallipolis (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 (ISBH) is a community-minded behavioral health organization serving Southwest and Central Ohio. The Credentialing Specialist handles provider credentialing and some client billing to support reimbursement for behavioral health services, primarily with Medicaid, and may interact with Medicare or private payers.

The role emphasizes maintaining provider profiles in CAQH, PECOS, and CMS databases, enrollments, and timely credentialing, with a pay range of

Qualifications

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

Responsibilities

• Maintain provider files for government and commercial payers credentialing.
• Track CAQH/PECOS/NPPES/CMS portal logins and update as needed.
• Update CAQH files per CMS/Medicare regulations.
• Complete NPI application for new providers.
• Terminate enrollments when providers resign or are terminated.
• Coordinate credentialing and re-credentialing with insurers.
• Follow up with payers to advance credentialing stages.

Skills

Credentialing knowledge

Medical billing

Communication skills

Organizational skills

Driver's license

Education

High school diploma or GED

Bachelor’s degree in accounting/credentialing

Tools

CAQH

PECOS

NPPES

CMS databases

EHR system

Job description

Integrated Services for Behavioral Health (ISBH) is a community-minded behavioral health organization serving Southwest and Central Ohio. The Credentialing Specialist handles provider credentialing and some client billing to support reimbursement for behavioral health services, primarily with Medicaid, and may interact with Medicare or private payers.

The role emphasizes maintaining provider profiles in CAQH, PECOS, and CMS databases, enrollments, and timely credentialing, with a pay range of