Provider Credentialing Specialist (remote in Oregon)

GOBHI has an immediate opening for a full-time Provider Credentialing Specialist. This remote position will be based out of the employees home located in the state of Oregon.

The Provider Credentialing Specialist plays a critical role in supporting GOBHIs 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 GOBHIs 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 GOBHIs/EOCCOs 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 GOBHIs 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.

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 to learn more about our mission and services.