Credentialing Specialist

Southeast, 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 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.

About the role

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.

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 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.
• 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, provide clarification, and facilitate problem resolution.
• Attend internal and external trainings as needed.
• Perform other tasks as needed to support the Integrated Services Billing Department.

Requirements

• A high school Diploma or GED equivalent is required.
• A bachelor’s degree in accounting, credentialing, or a related field is preferred.
• 1 year 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.

Skills

• Broad knowledge of community service systems is required.
• Knowledge of electronic health record systems is required.
• Excellent communication skills, both oral and written.
• Excellent organizational skills.
• 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.

Pay

$23.85 - $28.02 per hour based on experience, education, and/or licensure.

Benefits

• Medical
• Dental
• Vision
• Short-term Disability
• Long-term Disability
• 401K with Employer Match
• Employee Assistance Program (EAP)
• Generous paid time off