Insurance Billing and Credentialing Specialist

Job Overview
We are seeking a dynamic and detail-oriented Insurance Billing and Credentialing Specialist to join our healthcare team. In this vital role, you will be responsible for managing the billing processes with insurance providers, ensuring accurate and timely claims submission, and maintaining provider credentials in compliance with industry standards. Your expertise will help streamline revenue cycle operations, improve cash flow, and uphold the highest standards of credentialing integrity. This position offers an exciting opportunity to contribute to a patient-centered organization dedicated to excellence in healthcare delivery.

Key Responsibilities

Billing & Claims Management:

• Submit accurate and timely insurance claims (electronic and paper)
• Monitor claim status and follow up on unpaid or denied claims
• Review and resolve claim rejections and denials
• Post payments, adjustments, and reconcile accounts
• Verify client insurance eligibility and benefits
• Communicate with insurance companies regarding claims, authorizations, and payment issues

Credentialing & Enrollment:

• Manage provider credentialing and re-credentialing with insurance panels
• Complete and submit applications for new provider enrollments
• Maintain CAQH profiles and ensure all provider information is up to date
• Track credentialing status and follow up with payers as needed
• Ensure compliance with all payer, state, and federal regulations

Administrative & Compliance Duties:

• Maintain accurate and organized billing and credentialing records
• Stay up to date with changes in insurance policies, regulations, and billing practices
• Assist with audits and reporting as needed
• Collaborate with clinical and administrative staff to ensure accurate documentation for billing

Experience

• Proven experience in medical office billing, credentialing, or revenue cycle management within a healthcare setting.
• Strong knowledge of managed care plans, insurance claim processing, and medical terminology.
• Familiarity with CAQH standards and their application in provider credentialing processes.
• Excellent organizational skills with the ability to manage multiple priorities efficiently.
• Effective communication skills for liaising with insurance carriers, providers, and team members.
• Prior experience working in a fast-paced environment with attention to detail is highly preferred.
• Experience with electronic health records and billing systems
• Familiarity with insurance payers including Medicaid, Medicare, and commercial plans.

Join us to make a meaningful impact by ensuring accurate billing practices and maintaining impeccable provider credentials!

We’re committed to supporting your professional growth while fostering an energetic workplace dedicated to excellence in healthcare administration.

Pay: $15.00 - $18.00 per hour

Work Location: In person