Credentialing Manager

About the role

We are seeking a Credentialing Manager at Integrated Services for Behavioral Health (ISBH). ISBH is a community-minded, forward-thinking behavioral health organization serving Southeastern and Central Ohio. The Credentialing Manager oversees all provider credentialing, recredentialing, payer enrollment, and provider data management activities.

Responsibilities

• Oversee all provider credentialing, recredentialing, payer enrollment, and provider maintenance activities for ISBH
• Manage the credentialing team and coordinate daily workflow to ensure the timely completion of credentialing activities
• Ensure timely submission, tracking, and follow-up of credentialing and recredentialing applications to prevent lapses in provider participation
• Maintain provider credentialing files and databases, ensuring all licenses, certifications, registrations, and other required documentation remain current
• Monitor provider enrollment status with Ohio Medicaid, Medicare, commercial payers, and other contracted entities
• Serve as the primary resource for resolving complex credentialing and payer enrollment issues
• Develop, implement, and maintain credentialing policies, procedures, and quality assurance standards
• Monitor credentialing performance metrics and identify opportunities for process improvement and operational efficiency
• Collaborate with billing, compliance, human resources, clinical leadership, and provider relations teams to support organizational goals
• Attend virtual and in-person internal and external training, conferences, and meetings as appropriate
• Perform other duties as assigned

Requirements

• Education/Licensure: A high school diploma or GED equivalent is required; a bachelor’s degree in business, public health, healthcare administration, or a related field is preferred
• Experience: 5 years of experience in provider credentialing and payer enrollment in a healthcare setting is required; 3 years of supervisory or management experience in a healthcare credentialing role is required; experience with Ohio Medicaid provider enrollment and credentialing is required; experience working with credentialing systems and electronic health records is required; experience utilizing NPPES, CAQH, Ohio Medicaid PNM, and payer enrollment portals is required
• Knowledge, Skills, and Abilities: Knowledge of credentialing standards, provider enrollment requirements, and healthcare regulatory compliance; advanced analytical, organizational, and problem-solving skills; proficiency with databases, spreadsheets, and Microsoft Office applications; advanced communication skills, both oral and written; advanced organizational skills; knowledge of local, state, and federal regulations; the ability to maintain confidential information; ability to adhere to all safety rules, regulations, and requirements; a valid driver's license and the ability to operate a motor vehicle; appropriate level of auto insurance coverage; ability to manage deadlines within a fast-paced, high-volume environment; ability to operate in an Internet-based, automated office environment; ability to maintain a high-speed internet connection

Qualifications

• Education/Licensure: A high school diploma or GED equivalent is required; a bachelor’s degree in business, public health, healthcare administration, or a related field is preferred
• Experience: 5 years of experience in provider credentialing and payer enrollment in a healthcare setting is required; 3 years of supervisory or management experience in a healthcare credentialing role is required; experience with Ohio Medicaid provider enrollment and credentialing is required; experience working with credentialing systems and electronic health records is required; experience utilizing NPPES, CAQH, Ohio Medicaid PNM, and payer enrollment portals is required
• Knowledge, Skills, and Abilities: Knowledge of credentialing standards, provider enrollment requirements, and healthcare regulatory compliance; advanced analytical, organizational, and problem-solving skills; proficiency with databases, spreadsheets, and Microsoft Office applications; advanced communication skills, both oral and written; advanced organizational skills; knowledge of local, state, and federal regulations; the ability to maintain confidential information; ability to adhere to all safety rules, regulations, and requirements; a valid driver's license and the ability to operate a motor vehicle; appropriate level of auto insurance coverage; ability to manage deadlines within a fast-paced, high-volume environment; ability to operate in an Internet-based, automated office environment; ability to maintain a high-speed internet connection

Skills

• Knowledge of credentialing standards, provider enrollment requirements, and healthcare regulatory compliance
• Advanced analytical, organizational, and problem-solving skills
• Proficiency with databases, spreadsheets, and Microsoft Office applications
• Advanced communication skills, both oral and written
• Advanced organizational skills
• Knowledge of local, state, and federal regulations

Benefits

• Medical
• Dental
• Vision
• Short-term Disability
• Long-term Disability
• 401K w/ Employer Match
• Employee Assistance Program (EAP)