Credentialing Specialist

Job Description

Behavioral Health is seeking a Credentialing Specialist to work remote in North Dakota.
As a Credentialing Specialist, you will play a key role in ensuring billable State Hospital and Behavioral Health Clinic providers are appropriately credentialed and in-network with contracted insurance companies to support accurate and timely reimbursement. You will manage provider credentialing, recredentialing, updates, and provider corrections while collaborating closely with clinical, support, and revenue cycle teams to resolve issues that impact billing and reimbursement. This position is essential in supporting organizational revenue integrity and maintaining high standards of accuracy, professionalism, and compliance. 
In this role, you will ensure all provider credentials remain active and fully up to date within the electronic health record (EHR), tracking license renewals, credentials, taxonomies, and provider terminations. You will maintain and manage provider rosters across various insurance payer portals, submit timely updates, and process provider changes including name, location, role, and credential adjustments to maintain continuous payer compliance and prevent billing lapses. 
As part of your day-to-day responsibilities, you will also process and complete requests from providers regarding edits to their clinical notes, service information, and encounter details within the EHR to ensure compliance and proper billing alignment. You will also perform Admission, Discharge, and Transfer (A/D/T) corrections in the EHR, resolving discrepancies involving patient movement, service dates, and provider attribution. In executing these corrections, you will work closely with other team members, clinical staff, and administrative personnel to complete tasks, clarify data errors, ensure corrections are executed accurately and in a timely manner, track recurring trend patterns for leadership, and maintain positive, collaborative working relationships across departments. 
To be successful in this position, you must have a strong understanding of payer credentialing requirements, application processes, provider portal management, documentation standards, and organizational procedures. Your ability to review and maintain detailed provider documentation, communicate effectively with internal and external partners, and navigate EHR systems will be critical. You must be detail-oriented, highly organized, and capable of managing multiple priorities and deadlines independently in a fast-paced environment. 
To be considered for the Credentialing Specialist position, you must have:

• A high school diploma or GED.

• and at least 5 years of experience working in a healthcare or human services environment, including healthcare administration, clinical support, medical records, billing, insurance, patient access, or other healthcare support functions.

Preference will be given to candidates with experience working with electronic health records (EHRs) or other healthcare information systems; demonstrated experience managing provider rosters and payer portals; experience reviewing and maintaining detailed documentation for accuracy and completeness; and strong communication and collaboration skills with clinical staff, support staff, providers, and interdisciplinary teams.
Location
This position may work from home anywhere in North Dakota or bordering communities with the ability and willingness to travel for meetings and site visits as needed.
About HHS
ND HHS strives to make North Dakota the healthiest state in the nation by reinforcing the foundations of well-being: physical, economic, and behavioral. The keys to success are the 2800 committed, team members who are guided by a simple but powerful belief: when we lead with light, we create systems and services rooted in hope, clarity, and possibility. Their work is supported with more than $6 billion in funding from nearly 400 different federal, state, and special sources.

To succeed in this role, you must lead with LIGHT - leading with hope, instilling purpose and meaning, galvanizing gratitude, honoring health, and talking, walking and teaching civility, kindness and love for all.

About Team ND
"Far and away the best prize life offers is the chance to work hard at work worth doing." - Theodore Roosevelt
More than 7,500 talented, hard-working people across sixty-three agencies have come together as Team North Dakota. At Team ND, we are driven to succeed through gratitude, humility, curiosity and courage. Our purpose is to empower people, improve lives, and inspire success. Join us in being legendary.
Total Rewards: The State of North Dakota is committed to providing team members with a strong and competitive rewards package that support you, your health and your family.
Considering a new position on Team ND? How does your current position stack up? Use our Total Rewards Calculator to estimate.

Application Procedures
Your resume must clearly show the months and years of employment for each position listed. This information is required to accurately calculate your qualifying experience and determine whether you meet the minimum qualifications of the position. Resumes that do not include sufficient employment date may not be able to be fully evaluated. If the Department's Human Resource Division is unable to determine that you meet the minimum qualifications, credit will not be given. All application material must be received on or before the closing date by 11:59 PM Central Standard Time (CST).
Applicants must be legally authorized to work in the United States. The Department of Health & Human Services does not offer or provide sponsorships.
This employer participates in E-Verify. Please visit the following website for additional information HHS ND Careers E-Verify
A copy of your qualifying degrees transcript and any applicable certifications or licensures must be provided at the time of an interview.
For more information about the position or if you need an accommodation, please contact Lucy Olson at olsonlucy@nd.gov or at 701.328.8580.
Employing Unit ND HHS – Behavioral Health
TTY Number ND Relay Service 1 (800) 366-6888 (text) or 1 (800) 366-6889 (voice)
If you are experiencing technical difficulties with the Application Process or uploading attachments, please contact recruiter@nd.gov or (701) 328-3290.

Equal Employment Opportunity
The State of North Dakota and this hiring agency do not discriminate on the basis of race, color, national origin, sex (including sexual orientation and gender identity), genetics, religion, age or disability in employment or the provisions of services and complies with the provisions of the North Dakota Human Rights Act.
As an employer, the State of North Dakota prohibits smoking in all places of state employment in accordance with N.D.C.C. § 23-12-10.