Medicaid Credentialing Specialist & Billing Ops

Integratedservice; McConnelsville (OH); On-site; USD 68,340,000 - 80,289,000; Full time

Job summary

Integrated Services for Behavioral Health is seeking a Credentialing Specialist in Southeast, OH to manage provider credentialing and related billing tasks to support reimbursement for behavioral health services.

The role mainly handles Medicaid credentialing, with possible work with Medicare and other payers; duties include maintaining CAQH/NPPES/PECOS trackers, updating provider files, and coordinating enrollment with payers while ensuring timely credentialing.

Qualifications

• High school Diploma or GED is required.
• Bachelor's degree in accounting, credentialing, or a related field preferred.
• One year of credentialing experience in Ohio Behavioral Health Medicaid required.
• Three years of experience using an electronic health record system to process claims preferred.

Responsibilities

• Maintain provider files and credentialing applications.
• Track portals for CAQH, PECOS, NPPES, CMS, and payer logins.
• Update CAQH/NPPES/CMS databases timely per CMS requirements.
• Complete NPI applications for new providers.
• Terminate enrollment when providers resign or leave.

Skills

Credentialing knowledge

Communication skills

Organizational skills

Driver's license

Education

High school diploma or GED

Bachelor's degree in accounting/credentialing

Tools

CAQH

PECOS

NPPES

CMS databases

Job description

Integrated Services for Behavioral Health is seeking a Credentialing Specialist in Southeast, OH to manage provider credentialing and related billing tasks to support reimbursement for behavioral health services.

The role mainly handles Medicaid credentialing, with possible work with Medicare and other payers; duties include maintaining CAQH/NPPES/PECOS trackers, updating provider files, and coordinating enrollment with payers while ensuring timely credentialing.