Medicaid Credentialing & Billing Specialist

Integrated Services for Behavioral Health; Piketon (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 with Employer Match

Employee Assistance Program (EAP)

Job summary

Integrated Services for Behavioral Health is seeking a Credentialing Specialist to manage provider credentialing and related enrollment tasks in southern Ohio. The role focuses on Medicaid credentialing, with possible involvement in Medicare and private payers, and includes client billing support to assist reimbursement.

Responsibilities cover maintaining provider files, CAQH,NPPES, and PECOS, updating portal data, submitting NPI applications, and coordinating with insurers to ensure timely

Qualifications

• 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.

Responsibilities

• Maintain provider files with up-to-date information for government and commercial payer credentialing.
• Track CAQH, PECOS, NPPES, and CMS portal logins to ensure access is active.
• Update CAQH, PECOS, NPPES data per CMS/Moore schedules.
• Complete NPI applications for new providers.
• Terminate enrollments with government and commercial payers when providers resign or leave.
• Provide updated demographics to outside participants with supporting documents.
• Maintain provider profiles on CAQH, PECOS, NPPES, and CMS databases.
• Coordinate credentialing/re-credentialing and contracting with insurance companies.
• Contact payers to follow up on credentialing stages.
• Identify onboarding issues and facilitate problem resolution.

Skills

Communication skills

Organizational skills

Deadline management

Driver's license

Education

High school diploma or GED

Bachelor's degree in accounting/credentialing or related field

Tools

CAQH

PECOS

NPPES

CMS portals

Electronic Health Record (EHR)

Job description

Integrated Services for Behavioral Health is seeking a Credentialing Specialist to manage provider credentialing and related enrollment tasks in southern Ohio. The role focuses on Medicaid credentialing, with possible involvement in Medicare and private payers, and includes client billing support to assist reimbursement.

Responsibilities cover maintaining provider files, CAQH,NPPES, and PECOS, updating portal data, submitting NPI applications, and coordinating with insurers to ensure timely