Billing and Credentialing Specialist

Overview
We are seeking a detail-oriented and proactive Billing and Credentialing Specialist to join our dynamic healthcare team. In this vital role, you will ensure accurate billing processes, manage provider credentialing, and maintain compliance with industry standards. Your expertise will directly contribute to the seamless operation of our healthcare services, supporting both administrative efficiency and high-quality patient care. This position offers an exciting opportunity to work in a fast-paced environment where your skills in managed care, medical terminology, and compliance standards will make a meaningful impact.

Responsibilities

• Manage the complete billing cycle, including claim submission, follow-up, and resolution of denials to optimize revenue flow.
• Verify insurance coverage and benefits through managed care plans to ensure accurate billing and reimbursement.
• Maintain up-to-date provider credentials by coordinating with insurance companies and credentialing organizations in accordance with NCQA (National Committee for Quality Assurance) standards.
• Review medical documentation for accuracy and completeness, ensuring compliance with healthcare regulations and industry best practices.
• Collaborate with medical offices to gather necessary documentation and resolve credentialing issues promptly.
• Stay informed about changes in managed care policies, healthcare regulations, and NCQA standards to ensure ongoing compliance.
• Prepare detailed reports on billing activities, credentialing status, and compliance metrics for management review.

Experience

• Proven experience in medical billing, coding, or related administrative roles within a healthcare setting.
• Strong understanding of managed care processes and insurance claim procedures.
• Prior medical office experience is highly preferred, demonstrating familiarity with healthcare workflows.
• Knowledge of medical terminology is essential for accurate documentation review and communication.
• Experience working in environments that adhere to NCQA standards or similar accreditation requirements is a plus.
• Excellent organizational skills with the ability to manage multiple priorities efficiently.
• Strong communication skills to collaborate effectively with providers, insurance companies, and internal teams. Join us as a Billing and Credentialing Specialist and be part of a dedicated team committed to delivering exceptional healthcare services through precision, compliance, and compassionate support!

Pay: $21.00 - $24.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Flexible schedule
• Paid time off

Work Location: Hybrid remote in Warren, MI 48093