Credentialing Specialist

About the role

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. 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.

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,