Credentialing Specialist
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Job Description
Remote Credentialing Specialist maintaining provider licensure, insurance compliance, and billing claims for OhioGuidestone. Supporting mental health and substance use services across Ohio.
Responsibilities:
- 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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