Provider Credentialing Specialist (remote in Oregon) at Greater Oregon Behavioral Health

Portland, Oregon, United States -

Full Time

Start Date

Immediate

Expiry Date

27 Jan, 26

Salary

32.0

Posted On

29 Oct, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Provider Credentialing, Enrollment, Network Management, Medicaid, Managed Care, Behavioral Health, Credentialing Software, Organizational Skills, Communication Skills, Microsoft Suite, Google Suite, NCQA Standards, Confidentiality, Licensing, Background Checks, Provider Enrollment

Industry

Mental Health Care

Description

Description Here at GOBHI, we understand and support diversity by appreciating it and encouraging it by creating a culture of dignity and respect for our employees. We are honored to be an Equal Opportunity Employer. GOBHI has an immediate opening for a full-time Provider Credentialing Specialist. This remote position will be based out of the employee’s home located in the state of Oregon. The Provider Credentialing Specialist plays a critical role in supporting GOBHI’s mission to promote and coordinate high-quality behavioral health services across rural and frontier Oregon. This position is responsible for the full scope of provider credentialing, re-credentialing, and privileging processes, ensuring GOBHI’s provider network meets contractual, regulatory, and quality standards. Essential duties include: Coordinate and process all phases of initial credentialing, re-credentialing, and privileging for non-contracted behavioral health providers, ensuring compliance with GOBHI’s/EOCCO’s policies, OHA regulations, and Medicaid requirements. Conduct primary source verifications for licenses, certifications, education, malpractice insurance, professional references, and background checks. Conduct pre and routine checks of the List of Excluded Individuals or Entities (LEIE). Ensure timely submission of provider credentialing packets and follow-up documentation to support network adequacy and compliance. Review applications for accuracy and completeness, identifying any discrepancies or red flags requiring additional review. Maintain ongoing monitoring of provider credentials, including license expirations, malpractice coverage renewals, and sanctions/exclusions. Maintain and update accurate provider information in GOBHI’s credentialing database(s), including CAQH, OHA Provider Portal, and internal network systems. Support provider enrollment and revalidation processes for the Oregon Health Plan and other Medicaid programs. Liaise with OHA and other state entities regarding provider data discrepancies, enrollment timelines, and network requirements. Performs other duties as assigned. For a complete job description, please email hr@gobhi.org Requirements What is needed to succeed in this role: Two years’ experience in provider credentialing, enrollment, or network management with a Medicaid, managed care, or behavioral health organization. Strong understanding of Medicaid and OHA credentialing requirements, including Oregon Health Plan provider enrollment processes. Demonstrated proficiency with credentialing software systems (e.g., CAQH, OneHealthPort, or equivalent.) Excellent organizational skills with the ability to maintain accuracy under pressure. Strong written and verbal communication skills; ability to communication professionally with providers and regulatory agencies. Proficiency with Microsoft and Google Suite software. Knowledge of NCQA standards and managed care credential best practices. Handles highly sensitive and confidential information. Education – High School diploma or equivalent. Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Staff Management (CPMSM) through NAMSS preferred. What we offer: Competitive salary – $26.00 to $32.00 per hour, DOE Medical, dental and vision insurance for you and dependents 22 paid time off days and 12 paid holidays EAP FSA, with a $500 employer contribution Triple AAA insurance Mileage reimbursement Wellness benefits 401k contribution, including 6.5% employer contributions Cell phone and internet reimbursements About GOBHI: Founded in 1994, Greater Oregon Behavioral Health, Inc. is an innovative behavioral health organization that serves communities across Oregon. GOBHI is a 501(c)(3) nonprofit corporation that is charged with administering the behavioral health Medicaid benefit, non-emergent medical transportation and community engagement in 12 rural and frontier counties in Oregon. GOBHI is a co-owner of the Eastern Oregon Coordinated Care Organization, along with Moda Health, and also provides various direct services statewide. GOBHI is committed to better health, better care, and lower costs. Please visit www.gobhi.org to learn more about our mission and services.

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Responsibilities

The Provider Credentialing Specialist is responsible for the full scope of provider credentialing, re-credentialing, and privileging processes. This role ensures compliance with contractual, regulatory, and quality standards for GOBHI’s provider network.