Medicaid Credentialing & Billing Specialist

Integratedservice; Jackson (OH); On-site; USD 23,000 - 39,000; Full time

Job summary

Integrated Services for Behavioral Health (ISBH) seeks a Credentialing Specialist in Southeast, OH to manage provider credentialing and related billing operations. Primary focus on Medicaid enrollment with some Medicare/private payer work, timely CAQH/NPPES updates, and payer communications.

The ideal candidate has 1 year credentialing experience in Ohio Behavioral Health Medicaid and solid EHR claims processing familiarity, plus strong organizational and communication skills.

Qualifications

• A high school Diploma or GED equivalent is required.
• A bachelor’s degree in accounting, credentialing, or a related field is preferred.
• 1 year of credentialing experience in Ohio Behavioral Health Medicaid is required.
• 3 years of experience using an electronic health record system to process claims is preferred.
• Strong knowledge of CAQH, PECOS, NPPES, and CMS databases is expected.

Responsibilities

• Maintain individual provider files with up-to-date information for credentialing applications.
• Track CAQH, PECOS, NPPES, CMS portals and ensure logins are active.
• Keep CAQH database files updated per CMS and payer regulations.
• Complete a National Provider Identifier (NPI) application for new providers.
• Terminate enrollments when providers resign or are terminated.
• Coordinate credentialing timelines with payers and enrollment entities.
• Support billing operations and participate in payer communications as needed.
• Attend trainings and assist the Billing Department with other tasks.

Skills

Credentialing knowledge

Documentation accuracy

Communication skills

Deadline management

Education

High school diploma or GED

Bachelor's degree preferred

Tools

CAQH

PECOS

NPPES

CMS

Job description

Integrated Services for Behavioral Health (ISBH) seeks a Credentialing Specialist in Southeast, OH to manage provider credentialing and related billing operations. Primary focus on Medicaid enrollment with some Medicare/private payer work, timely CAQH/NPPES updates, and payer communications.

The ideal candidate has 1 year credentialing experience in Ohio Behavioral Health Medicaid and solid EHR claims processing familiarity, plus strong organizational and communication skills.