Credentialing Specialist

OhioGuidestone provides a complete continuum of responsive person-centered prevention services, mental health and substance use treatment, and wrap-around supports, serving the needs of over 50,000 people each year through telehealth and locations across Ohio. 

At OhioGuidestone, we believe a workforce comprised of employees from diverse backgrounds and communities, and a culture of belonging makes us a better organization. Together, we continue to build a workplace that encourages, supports, and celebrates the varied voices of our employees. 

Essential Functions:

•  Demonstrate the values and guiding principles of OhioGuidestone every day, performing with the highest standards of excellence, integrity and ethics.
• 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.
• Exhibit positivity, flexibility and a willingness to take on new responsibilities as requested or required.
• Present the Agency in the most positive light with all internal and external contacts.

Education & Experience:

• 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 is preferred.
• Experience with CAQHS preferred.
• Qualifications:
• Mission driven; strong desire to make an impact
• Effective interpersonal skills; able to speak effectively with individuals and/or groups of people
• Must have strong English reading, writing and verbal skills
• 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 customarily and regularly exercise discretion and good professional judgment
• Strong organizational skills; able to handle multiple priorities with strict attention to detail and perform work independently.
• Ability to maintain relevant, timely documentation as required.
• Effective computer literacy skills, including Windows applications, Microsoft Office Suite, and electronic health records, etc.
• 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.
• Possess a valid Ohio Driver’s License with a safe driving record and valid insurance.
• Successfully complete pre-employment screenings, including drug tests, background checks, and any other required assessments, such as a physical examination and TB test.