Medicaid Credentialing Specialist - Behavioral Health

Integrated Services for Behavioral Health; Coshocton (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

Employee Assistance Program (EAP)

Job summary

Integrated Services for Behavioral Health in Southeast, OH is seeking a Credentialing Specialist to manage provider credentialing processes with a Medicaid focus and assist with client billing to support reimbursement for behavioral health services.

The role emphasizes accurate data maintenance across CAQH, PECOS, NPPES, and CMS databases, as well as coordinating enrollment and re-credentialing with payer organizations.

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 individual provider files with up-to-date information for credentialing applications.
• Track CAQH, PECOS, NPPES, CMS portals and ensure logins are active.
• Update CAQH files for providers according to CMS/MediCare and MCO regulations.
• Complete NPI applications for new providers.
• Manage enrollment terminations with government and commercial payers.
• Provide updated demographic information to outside participants as needed.
• Maintain provider profiles on CAQH, PECOS, NPPES, and CMS databases.
• Coordinate credentialing and re-credentialing with insurance companies.
• Follow up with Managed Care Organizations and CMS/Medicare/Medicaid on credentialing stages.

Skills

Communication skills

Organizational skills

Driver's license

High-speed internet

Deadline management

Education

High school diploma or GED

Bachelor's degree in accounting, credentialing, or related field

Tools

Electronic health record system

Job description

Integrated Services for Behavioral Health in Southeast, OH is seeking a Credentialing Specialist to manage provider credentialing processes with a Medicaid focus and assist with client billing to support reimbursement for behavioral health services.

The role emphasizes accurate data maintenance across CAQH, PECOS, NPPES, and CMS databases, as well as coordinating enrollment and re-credentialing with payer organizations.