Medicaid Credentialing Specialist - Behavioral Health

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

Job summary

Integrated Services for Behavioral Health in Southeast Ohio seeks a Credentialing Specialist to manage provider credentialing, enrollments, and related operations. The role emphasizes Medicaid processing, with potential Medicare and private payer work.

Strong data accuracy and familiarity with CAQH, PECOS, NPPES, and CMS databases are essential. The position supports the Billing Department and aims to ensure smooth reimbursement for behavioral health services.

Qualifications

• 1 year credentialing experience in Ohio Medicaid required
• Knowledge of payer credentialing processes preferred
• Experience with CAQH/PECOS/NPPES and enrollment tracking is preferred
• High attention to detail and accuracy in documentation and data entry
• Strong communication and organizational skills required

Responsibilities

• Maintain provider files with up-to-date credentialing information
• Track CAQH, PECOS, NPPES, CMS portals and ensure logins are active
• Update provider CAQH files in line with CMS/Regulatory schedules
• Prepare NPI applications for providers
• Terminate enrollments with payers when needed
• Provide updated demographic data to outside entities
• Maintain provider profiles on CAQH, PECOS, NPPES and CMS databases
• Coordinate credentialing and recredentialing with insurance companies
• Follow up with Managed Care Organizations and CMS/Medicaid on credentialing stages
• Address onboarding issues and facilitate resolution
• Attend trainings and support Billing Department as needed
• Support documentation and data requests from the Billing Department

Skills

Credentialing knowledge

CAQH knowledge

CMS/Medicare/Medicaid processes

Provider enrollment

Communication

Organization

Driver's license

Education

High school Diploma or GED

Bachelor’s degree preferred

Tools

CAQH

PECOS

NPPES

CMS databases

Electronic health record system

Job description

Integrated Services for Behavioral Health in Southeast Ohio seeks a Credentialing Specialist to manage provider credentialing, enrollments, and related operations. The role emphasizes Medicaid processing, with potential Medicare and private payer work.

Strong data accuracy and familiarity with CAQH, PECOS, NPPES, and CMS databases are essential. The position supports the Billing Department and aims to ensure smooth reimbursement for behavioral health services.