Medicaid Credentialing Specialist

Integrated Services for Behavioral Health; Circleville (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

EAP

Job summary

Integrated Services for Behavioral Health (ISBH) is a community-minded behavioral health organization serving southeast and central Ohio. The Credentialing Specialist ensures provider enrollment across Medicaid, CMS, and commercial payers, maintaining CAQH, PECOS, NPPES, and CMS records.

Based in Ohio, the role supports reimbursement workflows and prepares NPI applications, enrollments, and terminations, while upholding accuracy and timely credentialing.

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.
• High school Diploma or GED; bachelor’s degree preferred in accounting/credentialing or related field.

Responsibilities

• Maintain provider files and up-to-date information for credentialing applications.
• Track CAQH, PECOS, NPPES, and CMS portals; ensure logins are active.
• Update CAQH database files timely per CMS/Medicare and payer regulations.
• Complete NPI applications for new providers.
• Terminate enrollments with government and commercial payers as needed.
• Provide demographic updates to external participants with supporting documents.
• Coordinate credentialing, re-credentialing, and contracting with insurers.
• Follow up with payers to resolve credentialing stages.

Skills

Excellent communication

Excellent organizational skills

Knowledge of EHR systems

Broad knowledge of community service

Driver's license

Internet-based office environment

High-speed internet

Deadline management

Auto insurance knowledge

Education

High school Diploma or GED

Bachelor’s degree in accounting/credentialing or related field (preferred)

Tools

CAQH

PECOS

NPPES

CMS databases

Job description

Integrated Services for Behavioral Health (ISBH) is a community-minded behavioral health organization serving southeast and central Ohio. The Credentialing Specialist ensures provider enrollment across Medicaid, CMS, and commercial payers, maintaining CAQH, PECOS, NPPES, and CMS records.

Based in Ohio, the role supports reimbursement workflows and prepares NPI applications, enrollments, and terminations, while upholding accuracy and timely credentialing.