Healthcare Credentialing & Enrollment Specialist

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

Job summary

Integrated Services for Behavioral Health in Southeast Ohio is seeking a Credentialing Specialist to manage provider enrollment and credentialing activities. You will maintain CAQH, PECOS, NPPES, and CMS portals, ensuring timely updates for all providers.

The role requires 1 year of credentialing experience in Ohio Behavioral Health Medicaid and 3 years of EMR claims processing experience is preferred. A valid driver’s license and strong communication and organizational skills are essential.

Qualifications

• 1 year credentialing experience in Ohio Behavioral Health Medicaid is required.
• Experience using an electronic health record system to process claims is preferred.
• Excellent communication and organizational skills are required.
• A valid driver’s license and the ability to operate a motor vehicle are required.
• Knowledge of CAQH/PECOS/NPPES and CMS credentialing workflows is preferred.

Responsibilities

• Maintain provider files and credentialing applications with up-to-date information.
• Track and manage CAQH, PECOS, NPPES, CMS portals and logins.
• Update CAQH provider files on CMS schedules.
• Submit new NPI applications for providers.
• Terminate enrollments with government and commercial payers as needed.
• Coordinate credentialing, re-credentialing, and contracting with insurers.
• Communicate with managed care organizations to follow up on credentialing stages.
• Attend trainings and support the Billing Department.

Skills

Communication skills

Organizational skills

Time management

Driver's license

Internet-based office tools

Education

High school diploma or GED

Bachelor’s degree preferred

Tools

CAQH

PECOS

NPPES

CMS databases

Job description

Integrated Services for Behavioral Health in Southeast Ohio is seeking a Credentialing Specialist to manage provider enrollment and credentialing activities. You will maintain CAQH, PECOS, NPPES, and CMS portals, ensuring timely updates for all providers.

The role requires 1 year of credentialing experience in Ohio Behavioral Health Medicaid and 3 years of EMR claims processing experience is preferred. A valid driver’s license and strong communication and organizational skills are essential.