Medicaid Credentialing Specialist & Payer Enrollments

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

Job summary

Integrated Services for Behavioral Health (ISBH) is seeking a Credentialing Specialist in the Southeast region of Ohio to support provider credentialing and related billing activities.

The role focuses on Medicaid credentialing with potential work with Medicare and private payers; a high school diploma is required, and 1 year of Medicaid credentialing experience is expected. Knowledge of CAQH/PECOS/NPPES/CMS systems is important.

Qualifications

• High school Diploma or GED required.
• Bachelor’s degree in accounting, credentialing, or related field preferred.
• 1 year of 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 and credentialing applications for government and commercial payers.
• Track CAQH, PECOS, NPPES, CMS portals; keep logins active.
• Update provider CAQH files per CMS, Medicare/Medicaid, and payer rules.
• Complete NPI applications for individuals.
• Terminate enrollments with payers when providers resign.
• Provide updated demographics to outside parties with required documents.
• Maintain provider profiles on CAQH, PECOS, NPPES, CMS databases.
• Coordinate credentialing, re-credentialing, and contracting with insurers.
• Contact payers to advance credentialing steps and resolve issues.
• Attend trainings and support Billing Department tasks as needed.

Skills

CAQH

PECOS

NPPES

CMS databases

Excellent communication

Strong organizational skills

Driver's license

Education

High school diploma

Bachelor's degree preferred

Tools

Electronic health record system

Job description

Integrated Services for Behavioral Health (ISBH) is seeking a Credentialing Specialist in the Southeast region of Ohio to support provider credentialing and related billing activities.

The role focuses on Medicaid credentialing with potential work with Medicare and private payers; a high school diploma is required, and 1 year of Medicaid credentialing experience is expected. Knowledge of CAQH/PECOS/NPPES/CMS systems is important.