Credentialing Specialist

OhioGuidestone • Berea, OH

4d

About The Position

Your story. Our mission. A perfect match. Your story. Our mission. A perfect match. You have a place at OhioGuidestone, the state's leader in behavioral health! OhioGuidestone is the state's leader in community behavioral health care, serving around 26,000 Ohioans each year. We focus on the needs of the whole person by providing telehealth and in-person prevention services, as well as mental health and substance use treatment. As we help people navigate the most difficult times in their lives—with compassion and respect—we ultimately empower them to take steps towards a healthier future. OhioGuidestone is seeking an experienced Credentialing Specialist who will perform with the highest standards of excellence, integrity and ethics. This full-time position is responsible for managing provider credentialing and recredentialing processes to ensure timely enrollment, regulatory compliance, and uninterrupted reimbursement.

Requirements

• Minimum educational level is a High School Diploma or GED with 5 or more years of experience in Credentialing.
• Skilled with Excel, and the Microsoft Office Suite.
• Mission driven; strong desire to make an impact
• Effective interpersonal skills; able to speak effectively with individuals and/or groups of people
• Must have strong English reading, writing and verbal skills
• Must be able to verbally exchange information in a confidential manner with employees, clients, students, participants, and/or families in various settings.
• Must be able to clearly and confidentially communicate with OhioGuidestone employees, clients, students, participants, and other stakeholders.
• Must have analytical ability to be self-sufficient in performing essential functions.
• Ability to customarily and regularly exercise discretion and good professional judgment
• Strong organizational skills; able to handle multiple priorities with strict attention to detail and perform work independently.
• Ability to maintain relevant, timely documentation as required.
• Effective computer literacy skills, including Windows applications, Microsoft Office Suite, and electronic health records, etc.
• May be asked to work flexible hours, which can include days, evenings, and weekends, as desired to meet the needs of clients and the OhioGuidestone.
• Possess a valid Ohio Driver's License with a safe driving record and valid insurance.
• Successfully complete 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/credentialing software programs is preferred.
• Experience with the PNM portal is preferred.

Responsibilities

• Demonstrate the values and guiding principles of OhioGuidestone every day, performing with the highest standards of excellence, integrity and ethics.
• Compiles, completes, and maintains current and accurate licensure data for all providers.
• Reviews insurance contracts and completes required information to ensure Agency compliance.
• Maintains knowledge of current health plan and Agency requirements for credentialing providers.
• Maintains provider information in online databases and system.
• Ensures practice addresses are current with health plans, agencies and other entities.
• Tracks licenses, DEA, and professional liability expirations for appointed providers.
• Protects organization's value by keeping information confidential.
• Develops an advanced understanding of any additional software installed or used in conjunction with the Agency's billing process.
• Works with the Billing staff to ensure resolution of unbilled claims and denials.
• Develops and maintains processes to increase the efficiency of the Billing department.
• Must maintain regular and reliable attendance to the satisfaction of management.
• Exhibit positivity, flexibility and a willingness to take on new responsibilities as requested or required.
• Present the Agency in the most positive light with all internal and external contacts.

Benefits

• NEW higher pay rates
• Clear career ladder for development path in various roles
• Competitive medical benefits including a low-premium medical plan option for employee or employee + children!
• Free CEU trainings
• 10 paid holidays; 3 are floating holidays
• Flexible work schedules to support work/life balance
• Flexible work opportunities to support varying career paths, job roles, intern to hire, and locations
• 401(k) with employer match option
• Employment Assistance Program (EAP)
• Mileage reimbursement
• Free licensure supervision
• Recognition and rewards

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 1,001-5,000 employees