Credentialing Specialist - Medicaid & Provider Onboarding

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

Job summary

Integrated Services for Behavioral Health seeks a Credentialing Specialist to manage provider credentialing with Medicaid focus in Ohio and support billing operations. You will maintain provider records, handle CAQH/NPPES/PECOS, and ensure timely recredentialing with insurers.

Requires EHR experience and strong organizational skills. Experience with payer enrollment, NPI applications, and CMS rules is essential.

Qualifications

• 1 year of credentialing in Ohio Behavioral Health Medicaid is required.
• 3 years of experience using an electronic health record system to process claims preferred.
• Knowledge of community service systems and payer credentialing processes.

Responsibilities

• Maintain provider files with up-to-date credentialing information for government and commercial payer applications.
• Track CAQH, PECOS, NPPES, CMS portals and ensure logins are active.
• Update CAQH files timely according to CMS regulations.
• Complete new provider NPI applications.
• Terminate enrollments with payers upon provider resignation or termination.
• Coordinate credentialing and re-credentialing processes with insurers.

Skills

Credentialing

Medicaid knowledge

EHR experience

Communication skills

Organizational skills

Driver's license

Time management

Education

High school diploma or GED

Bachelor’s degree in accounting/credentialing/related field

Tools

EHR system

CAQH

PECOS

NPPES

CMS portals

NPI applications

Job description

Integrated Services for Behavioral Health seeks a Credentialing Specialist to manage provider credentialing with Medicaid focus in Ohio and support billing operations. You will maintain provider records, handle CAQH/NPPES/PECOS, and ensure timely recredentialing with insurers.

Requires EHR experience and strong organizational skills. Experience with payer enrollment, NPI applications, and CMS rules is essential.