Credentialing Specialist

OhioGuidestone•Berea, OH

15h

About The Position

OhioGuidestone is a provider of prevention services, mental health and substance use treatment, and wrap-around supports through telehealth and locations across Ohio. The Credentialing Specialist supports the organization’s credentialing and billing processes by maintaining accurate provider licensure and credentialing information, ensuring compliance with insurance and Agency requirements, and assisting with claims and collections. The position requires confidentiality, reliable attendance, adaptability, professional judgment, and positive interactions with internal and external contacts. Flexible hours, including days, evenings, and weekends, may be requested to meet client and organizational needs.

Requirements

High school diploma or GED.
Five or more years of experience in credentialing.
Skilled in Excel and the Microsoft Office Suite.
Effective interpersonal skills and ability to speak effectively with individuals and groups.
Strong English reading, writing, and verbal skills.
Ability to exchange information verbally and confidentially with employees, clients, students, participants, and/or families in various settings.
Ability to communicate clearly and confidentially with OhioGuidestone employees, clients, students, participants, and other stakeholders.
Analytical ability to perform essential functions independently.
Ability to regularly exercise discretion and sound professional judgment.
Strong organizational skills, ability to manage multiple priorities with close attention to detail, and ability to work independently.
Effective computer literacy, including Windows applications, Microsoft Office Suite, and electronic health records.
Valid Ohio Driver’s License, safe driving record, and valid insurance.
Successfully complete required pre-employment screenings, including drug tests, background checks, and any other required assessments such as a physical examination and TB test.

Nice To Haves

Familiarity with accounting or credentialing software programs.
Experience with CAQH.

Responsibilities

Demonstrate OhioGuidestone’s values and guiding principles while maintaining high standards of excellence, integrity, and ethics.
Compile, complete, and maintain current and accurate licensure data for all providers.
Review insurance contracts and complete required information to ensure Agency compliance.
Maintain knowledge of current health plan and Agency credentialing requirements.
Maintain provider information in online databases and systems.
Ensure practice addresses are current with health plans, agencies, and other entities.
Track licenses, DEA registrations, and professional liability expirations for appointed providers.
Protect organizational information by maintaining confidentiality.
Work billing claims and collections as needed.
Develop an advanced understanding of software used in conjunction with the Agency’s billing process.
Work with Billing staff to resolve unbilled claims and denials.
Develop and maintain processes to increase the efficiency of the Billing department.
Maintain regular and reliable attendance to management’s satisfaction.
Demonstrate positivity, flexibility, and willingness to take on new responsibilities as requested or required.
Represent the Agency positively in interactions with internal and external contacts.
Maintain relevant and timely documentation as required.