Credentialing Specialist
$49,608–$58,282 year
On-siteSeaman, Ohio, United States
Job Summary
Process supporting provider credentialing applications and manage contracted Managed Care Organizations, commercial payers, CMS Medicare, Medicaid, PECOS, NPPES, and CAQH tracking logs. Update individual provider files, CAQH databases, and NPI applications while terminating enrollments upon provider resignation or termination. Coordinate monitoring and re-credentialing processes with insurance agencies, follow up on credentialing stages, and resolve onboarding issues or concerns. Provide updated demographic information to outside participants and support the Integrated Services Billing Department. Maintain accurate provider profiles to ensure timely credentialing and re-credentialing.
Required Qualifications
- A high school Diploma or GED equivalent
- 1 year of experience in credentialing in Ohio Behavioral Health Medicaid
- A broad knowledge of community service systems
- Knowledge of electronic health record systems
- Excellent communication skills, both oral and written
- Excellent organizational skills
- A valid driver's license and the ability to operate a motor vehicle
- An appropriate level of auto insurance coverage
- Ability to manage deadlines within a fast-paced, high-volume environment
- The ability to operate in an Internet-based, automated office environment
- The ability to maintain a high-speed internet connection
Desired Qualifications
- A bachelor's degree in accounting, credentialing, or a related field
- 3 years of experience using an electronic health record system to process claims
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