Credentialing Manager

Job not on LinkedIn

🕒 June 19

🏈 Ohio – Remote

🏈 Ohio – Remote

💵 $87k - $108k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Integrated Services of Appalachian Ohio

WebsiteLinkedInAll Job Openings

- employees

🏥 Healthcare

🌍 Social Impact

🧘 Wellness

Healthcare • Social Impact • Wellness

Integrated Services of Appalachian Ohio is a community mental health organization dedicated to delivering exceptional care through connection and focusing on the overall well-being of individuals and families. The organization offers a comprehensive range of services including counseling, substance use treatment, recovery housing, and behavioral health services tailored to meet the diverse needs of adults and youth. With a mission centered on dignity, collaboration, and innovation, ISBH works to create stronger communities by addressing mental health, housing, and support systems for those experiencing hardships in the Appalachian Ohio region.

📋 Description

• Oversee all provider credentialing, recredentialing, payer enrollment, and provider maintenance activities for ISBH • Manage the credentialing team and coordinate daily workflow to ensure the timely completion of credentialing activities • Responsible for performance management, recruitment, onboarding, and team development, including but not limited to implementing progressive discipline when necessary • Ensure timely submission, tracking, and follow-up of credentialing and recredentialing applications to prevent lapses in provider participation • Maintain provider credentialing files and databases, ensuring all licenses, certifications, registrations, and other required documentation remain current. • Monitor provider enrollment status with Ohio Medicaid, Medicare, commercial payers, and other contracted entities • Serve as the primary resource for resolving complex credentialing and payer enrollment issues • Ensure compliance with federal, state, accreditation, and payer-specific credentialing requirements • Develop, implement, and maintain credentialing policies, procedures, and quality assurance standards • Monitor credentialing performance metrics and identify opportunities for process improvement and operational efficiency • Collaborate with billing, compliance, human resources, clinical leadership, and provider relations teams to support organizational goals • Maintain expertise in credentialing regulations, payer requirements, provider enrollment processes, and industry best practices • Coordinate credentialing activities related to new programs, services, locations, and revenue streams • Participate in audits, accreditation reviews, and compliance activities as required • Attend virtual and in-person internal and external training, conferences, and meetings as appropriate • Maintain compliance with HIPAA, mandated reporting requirements, and professional ethical guidelines • Travel within the designated service area • Perform other duties as assigned

🎯 Requirements

• A high school diploma or GED equivalent is required • A bachelor's degree in business, Public Health, Healthcare Administration, or a related field is preferred • 5 years of experience in provider credentialing and payer enrollment in a healthcare setting is required • 3 years of supervisory or management experience in a healthcare credentialing role is required • Experience with Ohio Medicaid provider enrollment and credentialing is required • Experience working with credentialing systems and electronic health records is required • Experience utilizing NPPES, CAQH, Ohio Medicaid PNM, and payer enrollment portals is required • Knowledge of credentialing standards, provider enrollment requirements, and healthcare regulatory compliance • Ability to manage multiple projects, deadlines, and priorities independently • Advanced analytical, organizational, and problem-solving skills • Proficiency with databases, spreadsheets, and Microsoft Office applications • Advanced communication skills, both oral and written is required • Advanced organizational skills are required • Knowledge of local, state, and federal regulations is required • The ability to maintain confidential information is required • A valid driver's license and the ability to operate a motor vehicle are 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.

🏖️ Benefits

• Medical • Dental • Vision • Short-term Disability • Long-term Disability • 401K w/ Employer Match • Employee Assistance Program (EAP) provides support and resources to help you and your family with a range of issues.