Credentialing Specialist

Credentialing SpecialistIntegrated 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 Southeastern 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 conduct some client billing and other operations leading to reimbursement for behavioral health care and related services. The position is primarily focused on Medicaid, though may work with Medicare and/or private payers.The pay range for this position is $23.85 - $28.02 per hour based on experience, education, and/or licensure.Duties and Responsibilities: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 timely according to the schedule published by CMS Medicare/Medicaid and Managed Care Organizations regulations.Complete new individual provider application for National Provider Identifier (NPI).Terminating 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.Responsible for ensuring provider-collected information is current and accurate to ensure all individual providers are credentialed and recredentialed timely.Responsible for coordinating, monitoring, and maintaining the credentialing and re-credentialing process, re-credentialing, and contracting processes with insurance companies.Contacting Managed Care Organizations, Commercial plans, CMS Medicare, and Medicaid and/or other insurance agencies to follow up on several stages in credentialing.Identifies potential onboarding issues or concerns; research provides clarification, and facilitates 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 requiredA bachelor's degree in accounting, credentialing, or a related field is preferred.Experience:1 year of experience in credentialing in Ohio Behavioral Health Medicaid is required3 years of experience using an electronic health record system to process claims is preferredKnowledge, Skills, and Abilities:A broad knowledge of community service systems is requiredKnowledge of electronic health record systems is requiredExcellent communication skills, both oral and written is requiredExcellent organizational skills are requiredA valid driver's license and the ability to operate a motor vehicle is requiredAn appropriate level of auto insurance coverage is requiredAbility to manage deadlines within a fast-paced, high-volume environment is requiredThe ability to operate in an Internet-based, automated office environment is requiredThe ability to maintain a high-speed internet connection is requiredEnjoy a great work environment with an excellent salary, generous paid time off, and a strong benefits package!Benefits include:MedicalDentalVisionShort-term DisabilityLong-term Disability401K w/ Employer MatchEmployee Assistance Program (EAP)Our Vision: Healthy people. Strong communities.Our Mission: Delivering exceptional care through connection.Our Values:Dignity - We meet people where they are on their journey with respect and hope.Collaboration - We listen to understand and ask how we can best support the people and communities we serve.Wellbeing - We celebrate one another's strengths, and we support one another in being well.Excellence - We demand high-quality care for those we serve and are a leader in how we care for one another as a team.Innovation - We deeply value diversity of thought and experience, knowing it is what inspires us to stretch past where we are and reach towards what we know is possible.