Medical Credentialing Specialist

Wellness Grove is a mental health and wellness organization that’s here to make a difference and transform lives. We’re looking for talented and career-driven individuals to join our team. Our work environment is diverse, family and wellness oriented, fast-paced, challenging, and rewarding. If you’re looking for an opportunity for growth and development in your career, please send us your resume for consideration and review.

Reports To:
Medical Billing Manager

Work Schedule: (40 hours/week) (5-day work week)
Monday through Friday (8:00am to 5:00pm)

Salary Range:
$46,800 to $66,800/year

Benefits:

• Incentive Programs
• 2 Weeks Starting Vacation/PTO
• Bonuses & Recognition
• Advancement Opportunities
• Staff/Team Resources
• Professional Development & Learning
• Additional Perks

Location:
Canton, OH

Work Remotely:
No

REQUIRED EXPERIENCE & EXPECTATIONS:

• Minimum of 2–3 years of experience in medical credentialing, with a strong understanding of healthcare regulatory requirements and standards.
• Experience with provider enrollment processes for insurance companies, Medicare, Medicaid, and other third-party payers.
• Strong knowledge of federal, state, and local regulations related to medical credentialing and compliance.
• Excellent organizational skills with the ability to manage multiple tasks and deadlines.
• Strong attention to detail and accuracy in managing documentation and records.
• Excellent communication and interpersonal skills, with the ability to work collaboratively with internal and external stakeholders.
• Proactive, adaptable, and solutions-oriented with the ability to thrive in a fast-paced and evolving environment.
• Intermediate knowledge of Office 365 (Word, Excel, PowerPoint, etc.).
• Moderate to fast typing skills (40–80 wpm or more), with the ability to pass a typing test and potentially other tests during the interview process (e.g., MS Office).
• Willingness to learn and follow Wellness Grove standards and best practices.
• Motivated, driven for success, and able to maintain a positive attitude under pressure.

Preferred Experience & Expectations: (not required)

• Experience in a mental health or wellness organization, with specific knowledge of credentialing requirements for mental health providers, including experience with credentialing mental health therapists with insurance carriers.
• Certification in medical credentialing (e.g., Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM).
• Experience with credentialing software or electronic health record (EHR) systems.
• Experience with mental health billing processes, regulations, and best practices.
• Experience with electronic health records (EHR) platforms.
• Experience with Fortune 500 organizations.

Roles & Responsibilities:

• Facilitate the credentialing and re-credentialing processes of the group and for associated healthcare providers, ensuring all required documentation, licenses, and certifications are current and accurate.
• Assist in ensuring compliance with all relevant federal, state, and local regulations, as well as industry standards for credentialing.
• Support provider enrollment with insurance companies, Medicare, Medicaid, and other third-party payers to ensure timely reimbursement for services rendered.
• Collaborate with multiple specialty teams, including billing, contracting, benefit verification, claims, and collections.
• Maintain accurate and up-to-date records for all credentialed providers, including tracking expiration dates for licenses and certifications and ensuring timely renewals.
• Prepare for and participate in internal and external audits of the credentialing process, ensuring all documentation is complete and compliant.
• Work closely with the human resources department, clinical leadership, and administrative teams to coordinate onboarding and credentialing of new providers.
• Address and resolve any issues related to credentialing delays, discrepancies, or denials, working with providers and third-party payers as necessary.
• Provide assistance with developing and updating policies and procedures related to the credentialing process, ensuring they reflect current best practices and regulatory requirements.
• Provide regular updates to leadership on the status of credentialing activities, including any potential risks or areas for improvement.
• Identify opportunities for process improvements in the credentialing function and implement changes to enhance efficiency and compliance.

Wellness Grove, LLC is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, age, national origin, protected veteran status, disability, or any other basis protected by federal, state, or local law. Applicants have rights under Federal Employment Laws.

Job Type: Full-time

Pay: $46,800.00 - $66,800.00 per year

Benefits:

• Paid time off

Schedule:

• Day shift

Application Question(s):

• Do you have experience with provider enrollment processes for insurance companies, Medicare, Medicaid, and other third-party payers?
• Do you possess specific knowledge of credentialing requirements for mental health providers, including experience with credentialing mental health therapists with insurance carriers?

Experience:

• medical credentialing: 2 years (Required)

Ability to Commute:

• Canton, OH 44718 (Required)

Ability to Relocate:

• Canton, OH 44718: Relocate before starting work (Required)

Work Location: In person

Salary : $46,800 - $66,800