Credentialing Specialist

Integrated Services for Behavioral Health•Columbus, OH

6d•Onsite

About The Position

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 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.

Requirements

A high school Diploma or GED equivalent is required
1 year of experience in credentialing in Ohio Behavioral Health Medicaid is required
A broad knowledge of community service systems is required
Knowledge of electronic health record systems is required
Excellent communication skills, both oral and written is required
Excellent organizational skills are required
A valid driver's license and the ability to operate a motor vehicle is required
An appropriate level of auto insurance coverage is required
Ability to manage deadlines within a fast-paced, high-volume environment is required
The ability to operate in an Internet-based, automated office environment is required
The ability to maintain a high-speed internet connection is required

Nice To Haves

A bachelor’s degree in accounting, credentialing, or a related field is preferred.
3 years of experience using an electronic health record system to process claims is preferred

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).
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 in a timely.
Responsible for coordinating, monitoring, and maintaining the credentialing and re-credentialing process, re-credentialing, and contracting processes with insurance companies.
Contacting Managed Care Organizations, Commercial plans, CMS Medicare, Medicaid and/or other insurance agencies to follow up on several stages in credentialing.
Identifies potential onboarding issues or concerns; research provides clarification, and facilitates problem resolution.
Attend internal and external trainings as needed.
Other tasks as needed to support the Integrated Services Billing Department.