Credentialing Specialist — Payer Enrollment & Compliance

Integrated Services for Behavioral Health; Newark (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 hiring a Credentialing Specialist in Southeast Ohio. You will maintain provider files and ensure timely credentialing across commercial and government payers, updating CAQH/NPPES/PECOS data in line with CMS regulations.

You will coordinate, monitor, and complete NPI applications, manage enrollments, and support the Billing Department while communicating with insurers and providers.

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 with an electronic health record system to process claims preferred.

Responsibilities

• Maintain provider files for government and commercial payer credentialing apps.
• Track CAQH, PECOS, NPPES, CMS portals; keep logins active.
• Update CAQH/NPPES/PECOS data per CMS/Medicare/Medicaid regulations.
• Complete NPI applications for providers.
• Terminate enrollments when providers leave.
• Provide updated demographics to external participants as needed.
• Maintain provider profiles on CAQH, PECOS, NPPES, CMS databases.
• Coordinate credentialing, re-credentialing, and contracting with insurance carriers.

Skills

Credentialing

CAQH

PECOS

NPPES

CMS

Communication

Organization

Education

High school diploma or GED

Bachelor’s degree (preferred)

Tools

EHR software

PECOS portal

NPPES portal

Job description

Integrated Services for Behavioral Health (ISBH) is hiring a Credentialing Specialist in Southeast Ohio. You will maintain provider files and ensure timely credentialing across commercial and government payers, updating CAQH/NPPES/PECOS data in line with CMS regulations.

You will coordinate, monitor, and complete NPI applications, manage enrollments, and support the Billing Department while communicating with insurers and providers.