Credentialing Manager

Job not on LinkedIn

🕒 June 19

🏈 Ohio, Washington – Remote

🏈 Ohio – Remote ☕ Washington – Remote

💵 $87k - $108k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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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 bachelors 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 • Ability to adhere to all safety rules, regulations, and requirements • 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.