Medicaid Credentialing Specialist

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

Job summary

Integrated Services for Behavioral Health in Ohio is seeking a Credentialing Specialist to manage provider credentialing and related billing tasks. This role focuses on Medicaid credentialing and ensures timely enrollment with insurers, ensuring accurate provider profiles and enrollment statuses.

The position requires attention to detail, knowledge of CAQH/PECOS/NPPES/CMS processes, and strong communication to coordinate with plans and CMS regulators. Competitive pay and benefits offered.

Qualifications

• Strong knowledge of credentialing processes and payer enrollment requirements.
• Experience with CAQH, PECOS, NPPES, CMS and Medicaid/Medicare enrollment processes.
• Ability to manage deadlines in a fast-paced environment.

Responsibilities

• Maintain provider files for government and commercial credentialing applications.
• Track CAQH, PECOS, NPPES, and CMS portal activity and ensure logins are active.
• Update provider CAQH files in line with CMS/Medicaid schedules.
• Submit new NPI applications for providers.
• Terminate enrollments when providers resign or are terminated.
• Coordinate with payers and billing entities on credentialing steps.
• Maintain provider profiles in CAQH/PECOS/NPPES/CMS databases.
• Support credentialing and contracting with insurance plans.

Skills

Effective communication

Organizational skills

Driver's license

Attention to detail

Education

High school diploma or GED

Bachelor’s degree preferred

Job description

Integrated Services for Behavioral Health in Ohio is seeking a Credentialing Specialist to manage provider credentialing and related billing tasks. This role focuses on Medicaid credentialing and ensures timely enrollment with insurers, ensuring accurate provider profiles and enrollment statuses.

The position requires attention to detail, knowledge of CAQH/PECOS/NPPES/CMS processes, and strong communication to coordinate with plans and CMS regulators. Competitive pay and benefits offered.