Provider Credentialing & Enrollment Specialist

Integratedservice; Hillsboro (OH); Vor Ort; USD 33.000 - 39.000; Vollzeit

Zusammenfassung

Integrated Services for Behavioral Health is seeking a Credentialing Specialist to manage provider credentialing and related billing tasks in Southeast, OH. This role focuses on Medicaid credentialing, with potential Medicare/private payer interactions.

The position requires 1 year of credentialing experience in Ohio Behavioral Health Medicaid and includes responsibilities for CAQH, PECOS, NPPES, and CMS portal maintenance. A strong team focus and attention to detail are essential.

Qualifikationen

• 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.
• High school diploma or GED required; bachelor's degree preferred in accounting/credentialing or related field.

Aufgaben

• Maintain provider files for credentialing applications and required governmental/commercial payer credentials.
• Track CAQH, PECOS, NPPES, CMS portals to keep logins active.
• Update provider CAQH files timely per CMS/Medicaid schedules.
• Complete NPI applications for new providers.
• Terminate enrollments with government and commercial payers when providers resign or are terminated.
• Coordinate credentialing, re-credentialing and contracting with insurers.
• Communicate with managed care plans and billing entities as needed.

Kenntnisse

Communication

Organizational

Driver's license

Auto insurance

Deadline-driven

Internet-based office

Ausbildung

High school diploma or GED

Bachelor's degree preferred

Tools

EHR systems

Jobbeschreibung

Integrated Services for Behavioral Health is seeking a Credentialing Specialist to manage provider credentialing and related billing tasks in Southeast, OH. This role focuses on Medicaid credentialing, with potential Medicare/private payer interactions.

The position requires 1 year of credentialing experience in Ohio Behavioral Health Medicaid and includes responsibilities for CAQH, PECOS, NPPES, and CMS portal maintenance. A strong team focus and attention to detail are essential.