Credentialing Specialist

OhioGuidestoneprovides a complete continuum of responsive person-centered prevention services, mental health and substance use treatment, and wrap-around supports, serving the needs of over 50,000 people each year through telehealth and locations across Ohio.

AtOhioGuidestone, we believe a workforcecomprisedof employees from diverse backgrounds andcommunities,and a culture of belonging makes us a better organization. Together, we continue to build a workplace that encourages, supports, and celebrates the varied voices of our employees.

Essential Functions:

• Demonstrate the values and guiding principles of OhioGuidestone every day, performing with the highest standards of excellence, integrity and ethics.
• Compiles, completes, and maintains current and accurate licensure data for all providers.
• Reviews insurance contracts and completes required information to ensure Agency compliance.
• Maintains knowledge of current health plan and Agency requirements for credentialing providers.
• Maintains provider information in online databases and system.
• Ensures practice addresses are current with health plans, agencies and other entities.
• Tracks licenses, DEA, and professional liability expirations for appointed providers.
• Protects organization's value by keeping information confidential.
• Works billing claims and collections as needed.
• Develops an advanced understanding of any additional software installed or used in conjunction with the Agency's billing process.
• Works with the Billing staff to ensure resolution of unbilled claims and denials.
• Develops and maintains processes to increase the efficiency of the Billing department.
• Must maintain regular and reliable attendance to the satisfaction of management.
• Exhibit positivity, flexibility and a willingness to take on new responsibilities as requested or required.
• Present the Agency in the most positive light with all internal and external contacts.

Education & Experience:

• Minimum educational level is a High School Diploma or GED with 5 or more years of experience in Credentialing.
• Skilled with Excel, and the Microsoft Office Suite.
• Familiarity with accounting/credentialing software programs is preferred.
• Experience with CAQHS preferred.
• Qualifications:
• Mission driven; strong desire to make an impact
• Effective interpersonal skills; able to speak effectively with individuals and/or groups of people
• Must have strong English reading, writing and verbal skills
• Must be able to verbally exchange information in a confidential manner with employees, clients, students, participants, and/or families in various settings.
• Must be able to clearly and confidentially communicate with OhioGuidestone employees, clients, students, participants, and other stakeholders.
• Must have analytical ability to be self-sufficient in performing essential functions.
• Ability to customarily and regularly exercise discretion and good professional judgment
• Strong organizational skills; able to handle multiple priorities with strict attention to detail and perform work independently.
• Ability to maintain relevant, timely documentation as required.
• Effective computer literacy skills, including Windows applications, Microsoft Office Suite, and electronic health records, etc.
• May be asked to work flexible hours, which can include days, evenings, and weekends, as desired to meet the needs of clients and the OhioGuidestone.
• Possess a valid Ohio Driver's License with a safe driving record and valid insurance.
• Successfully complete pre-employment screenings, including drug tests, background checks, and any other required assessments, such as a physical examination and TB test.

Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.