Medicaid Credentialing Specialist | Billing & Admin

Integratedservice; Athens (OH); On-site; USD 50,000 - 58,000; Full time

Benefits offered by this job

Paid time off

Benefits package

Job summary

Integrated Services for Behavioral Health seeks a Credentialing Specialist to manage provider credentialing and related billing operations. Primary focus is Medicaid with possible Medicare/private payer work, including updating CAQH/NPPES/PECOS and handling NPI applications.

Responsibilities include maintaining provider files, tracking enrollments, and coordinating credentialing with insurers. Candidates should have relevant education and at least 1 year Ohio Medicaid credentialing experience.

Qualifications

• High school diploma or GED required.
• Bachelor’s degree preferred in accounting or credentialing or related field.
• 1 year credentialing experience in Ohio Behavioral Health Medicaid required.
• 3 years of experience using an electronic health record system to process claims preferred.

Responsibilities

• Maintain provider files for government and commercial payer credentialing applications.
• Track CAQH, PECOS, NPPES, and CMS enrollment and logins for active portals.
• Update CAQH files per CMS, Medicare/Medicaid, and payer rules.
• Complete NPI applications for providers.
• Terminate enrollments when providers resign or are terminated.
• Provide updated demographics to outside participants with supporting docs.
• Maintain provider profiles on CAQH, PECOS, NPPES, CMS databases.
• Coordinate credentialing, re-credentialing, and contracting with insurers.
• Follow up with Managed Care Organizations and plans on credentialing stages.
• Attend trainings; support Integrated Services Billing Department.

Skills

Communication skills

Organizational skills

EHR knowledge

Payer credentialing

Driver's license

Internet access

Deadline management

Healthcare billing

Education

High school diploma or GED

Bachelor's degree in accounting/credentialing or related field

Tools

CAQH

PECOS

NPPES

CMS portals

Job description

Integrated Services for Behavioral Health seeks a Credentialing Specialist to manage provider credentialing and related billing operations. Primary focus is Medicaid with possible Medicare/private payer work, including updating CAQH/NPPES/PECOS and handling NPI applications.

Responsibilities include maintaining provider files, tracking enrollments, and coordinating credentialing with insurers. Candidates should have relevant education and at least 1 year Ohio Medicaid credentialing experience.