Credentialing Specialist

We are seeking a Credentialing Specialist! Hybrid, OH Integrated Services for Behavioral Health (ISBH) is a community-minded, forward-thinking behavioral health organization helping people along the road to health and well-being. We meet people in their homes and communities and help connect them to the resources they need. We serve Southeast and Central Ohio with a comprehensive array of behavioral health and other services – working with local partners to promote healthy people and strong communities. All our services are intended to be collaborative and personalized for the individual. The Credentialing Specialist is responsible for processing supporting provider credentialing processes as well as conducting some client billing and other operations leading to reimbursement for behavioral health care and related services. The position is primarily focused on Medicaid, though it may work with Medicare and/or private payers. Essential Functions Maintain individual provider files to include up-to-date information needed to complete the required governmental and commercial payer credentialing applications. Maintain contracted Managed Care Organizations, commercial payers, CMS Medicare, Medicaid, PECOS, NPPES, and CAQH tracking log to ensure all necessary portals logins are active and available. Work with individual providers to ensure each provider's CAQH database files are updated in a timely manner according to the schedule published by CMS, Medicare/ Medicaid, and Managed Care Organizations regulations. Complete a new individual provider application for the National Provider Identifier (NPI). Terminate enrollment with government and commercial payers upon resignation or termination of providers. As directed, provide updated demographic information with supporting documents to outside participants, such as commercial managed care plans and contracted billing entities. Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases. Ensure provider-collected information is current and accurate to ensure all individual providers are credentialed and recredentialed in a timely manner. Coordinate, monitor, and maintain the credentialing and re-credentialing process, re-credentialing, and contracting processes with insurance companies. Contact Managed Care Organizations, Commercial plans, CMS Medicare, Medicaid and/or other insurance agencies to follow up on several stages in credentialing. Identify potential onboarding issues or concerns; research provides clarification, and facilitate problem resolution. Attend internal and external trainings as needed. Other tasks as needed to support the Integrated Services Billing Department. Education / Licensure A high school Diploma or GED equivalent is required. A bachelor’s degree in accounting, credentialing, or a related field is preferred. Experience 3 years of experience in credentialing in Ohio Behavioral Health Medicaid is required. 3 years of experience using an electronic health record system to process claims is preferred. Knowledge, Skills, and Abilities A broad knowledge of community service systems is required. Knowledge of electronic health record systems is required. Excellent communication skills, both oral and written, are required. Excellent organizational skills are required. A valid driver's license and the ability to operate a motor vehicle is required. An appropriate level of auto insurance coverage is required. Ability to manage deadlines within a fast-paced, high-volume environment is required. The ability to operate in an Internet-based, automated office environment is required. The ability to maintain a high-speed internet connection is required. Benefits Medical Dental Vision Short-term Disability Long-term Disability 401K with Employer Match Employee Assistance Program (EAP) To learn more about our organization: The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this position. It is not to be construed as an exhaustive list of duties performed by the individuals in this role, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under their supervision. We’re an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status. #J-18808-Ljbffr