Credentialing Specialist

🔥 11 minutes ago

🏈 Ohio – Remote

🏈 Ohio – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 12%

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OhioGuidestone

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1864

🏥 Healthcare

🤝 Non-profit

🤲 Charity

Healthcare • Non-profit • Charity

OhioGuidestone is a nonprofit behavioral health and human services organization based in Ohio that provides comprehensive mental health, substance use, early childhood, family support, and vocational training services. It operates outpatient and residential treatment programs, ReadyCare walk-in behavioral health clinics, mobile crisis and stabilization, psychiatric services for children and adults, telehealth, and care coordination across many Ohio counties. The organization also engages in clinical innovation, accepts donations, and offers workforce development and community-based supports to help individuals and families achieve healthier, more stable lives.

📋 Description

• Compile, complete, and maintain current and accurate licensure data for all providers • Review insurance contracts and complete required information for agency compliance • Maintain knowledge of current health plan and agency credentialing requirements • Maintain provider information in online databases and systems • Ensure practice addresses are current with health plans, agencies, and other entities • Track licenses, DEA registrations, and professional liability expirations for appointed providers • Protect organizational information by maintaining confidentiality • Work billing claims and collections as needed • Develop an advanced understanding of software used in the agency billing process • Work with Billing staff to resolve unbilled claims and denials • Develop and maintain processes to improve Billing department efficiency • Maintain regular and reliable attendance • Demonstrate OhioGuidestone values, ethics, positivity, flexibility, and willingness to take on new responsibilities • Represent the agency positively with internal and external contacts

🎯 Requirements

• High School Diploma or GED and 5 or more years of experience in Credentialing • Skilled with Excel and the Microsoft Office Suite • Familiarity with accounting/credentialing software programs preferred • Experience with CAQH preferred • Strong English reading, writing, and verbal skills • Effective interpersonal and communication skills • Analytical ability to perform essential functions independently • Ability to exercise discretion and professional judgment • Strong organizational skills and ability to manage multiple priorities with attention to detail • Ability to maintain relevant, timely documentation • Computer literacy, including Windows applications, Microsoft Office Suite, and electronic health records • May be asked to work flexible hours, including days, evenings, and weekends • Valid Ohio Driver’s License, safe driving record, and valid insurance • Successful completion of pre-employment screenings, including drug tests, background checks, and other required assessments such as physical examination and TB test

🏖️ Benefits

• Remote work arrangement • Flexible hours, potentially including days, evenings, and weekends • Telehealth and location-based service environment • Diverse, inclusive, and belonging-focused workplace culture

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