Credentialing Specialist

Where New Paths Begin

OhioGuidestone is the state’s leader in community behavioral health care, serving around 26,000 Ohioans each year. We focus on the needs of the whole person by providing telehealth and in-person prevention services, as well as mental health and substance use treatment. As we help people navigate the most difficult times in their lives—with compassion and respect—we ultimately empower them to take steps towards a healthier future.

Duties/Responsibilities:

• Compiles, completes, and maintains current and accurate licensure data for all providers.

• Reviews insurance contracts and completes required information to ensure Agency compliance.
• Maintains knowledge of current health plan and Agency requirements for credentialing providers.
• Maintains provider information in online databases and system.
• Ensures practice addresses are current with health plans, agencies and other entities.
• Tracks licenses, DEA, and professional liability expirations for appointed providers.
• Protects organization's value by keeping information confidential.
• Works billing claims and collections as needed.
• Develops an advanced understanding of any additional software installed or used in conjunction with the Agency’s billing process.
• Works with the Billing staff to ensure resolution of unbilled claims and denials.
• Develops and maintains processes to increase the efficiency of the Billing department.

• Must maintain regular and reliable attendance to the satisfaction of management.
• Exhibits positivity, flexibility and a willingness to take on new responsibilities as requested or required.
• Demonstrates positive leadership, promote a team-based work environment and present the Agency in the most positive light with all internal and external contacts.
• Employee may be asked to complete related duties other than those indicated above as assigned by their supervisor.

Required Skills/Abilities:

• Must have strong English reading, writing and verbal skills
• Computer literacy skills, including Windows applications, Microsoft Office Suite, and basic database usage, as well as basic typing.
• Must be able to verbally exchange information in a confidential manner with employees, clients, students, participants, and/or families in various settings.
• Must be able to clearly and confidentially communicate with OhioGuidestone employees, clients, students, participants, and other stakeholders.
• Must have analytical ability to be self-sufficient in performing essential functions.
• Ability to set priorities, meet deadlines, and manage multiple tasks.

Performance/Physical Requirements:

• Must be able to remain in a stationary position 75%-100% of the time.
• Must be able to visually read written and digital information.
• Must be able to visually determine the accuracy, neatness, and thoroughness of work assigned and/or to make general observations of facilities or structures.
• Must be able to receive detailed information through oral communication.
• Must be able to dictate with clients, students, participants, co-workers, and supervisors using all means of communication including but not limited to, in-person, phone, and computer.
• May be asked to work flexible hours, which can include days, evenings, and weekends, as desired to meet the needs of clients and the OhioGuidestone.
• Must adhere to all Our Promise Values and Guiding Principles.

Qualifications:

• Minimum educational level is a High School Diploma or GED with 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 CAQHS preferred.
• Must have a valid Ohio Driver’s License with a safe driving record and valid insurance.
• Ability to take and pass a physical exam and drug screening.
• Employment is contingent upon clear results of a thorough background check.

Benefits include:

• Free CEU trainings
• Competitive medical benefits including a zero-cost monthly option for employee or employee children!
• 10 paid holidays; three are exchangeable
• Flexible work schedules to support work/life balance
• Flexible work opportunities to support varying career paths, job roles, intern-to-hire, and locations
• 401(k) with employer match option
• Employment Assistance Program (EAP)
• Mileage reimbursement
• Recognition and rewards

At OhioGuidestone we care about the health and safety of our employees. OhioGuidestone requires applicants to complete a pre-employment screening process upon receipt of an offer of employment. We require and cover the cost of a fingerprint background screening, physical, Tuberculosis test, and drug screen after an employment offer is made. Any employment offer is contingent upon receipt of all satisfactory pre-employment screenings.

OhioGuidestone is committed to creating a more diverse community. We encourage candidates from historically underrepresented groups to apply. EEO/M/F/H/V