Medical Billing and Credentialing Specialist

Job Title: Medical Billing and Credentialing Specialist
Company: Deosai Medical Services
Location: I-8, Islamabad (On-site)
Job Type: Full-time
Reports To: Medical Billing and Credentialing Manager

Job Summary:

The Medical Billing and Credentialing Specialist at Deosai Medical Services is responsible for overseeing all billing processes and managing provider credentialing. The role ensures timely and accurate submission of claims to insurance companies while verifying the credentials of healthcare providers to maintain compliance with regulatory standards. This specialist will work closely with providers, insurance companies, and internal teams to optimize billing accuracy and ensure proper credentialing.

Key Responsibilities:

Billing:

• Submit and process medical claims to insurance companies in compliance with all regulations.
• Ensure accuracy in coding (CPT, ICD-10, HCPCS), modifiers, and documentation before submission.
• Follow up on denied or rejected claims and manage appeals as necessary.
• Track and resolve outstanding accounts receivables.
• Send out patient bills, handle inquiries, and process payments.
• Maintain accurate patient and insurance records

Credentialing:

• Manage credentialing and re-credentialing processes for healthcare providers.
• Ensure all providers comply with state and federal regulations, including licenses and certifications.
• Complete and submit credentialing applications to insurance carriers and healthcare organizations.
• Track credentialing status and resolve any delays or discrepancies.
• Maintain up-to-date provider contracts, credentialing records, and licensing.

Compliance & Reporting:

• Stay updated on billing and credentialing regulations to ensure compliance.
• Generate reports on billing and credentialing activities.
• Assist with internal audits to ensure adherence to best practices and regulations.

Collaboration:

• Coordinate with healthcare providers to gather necessary documentation for billing and credentialing.
• Collaborate with insurance companies to resolve claims and credentialing issues.
• Work with finance and administrative teams to improve the revenue cycle.

Qualifications:

• High school diploma or equivalent required; Associate’s or Bachelor’s degree in healthcare administration, business, or related field preferred.
• Proficiency in the English language

Experience:

• 2+ years of experience in medical billing, coding, and credentialing.
• Strong knowledge of billing practices, insurance regulations, and credentialing procedures.
• Experience with medical billing software and EHR systems (e.g., Epic, Kareo, AdvancedMD).

Skills:

• Knowledge of CPT, ICD-10, and HCPCS coding standards.
• Familiarity with Medicare, Medicaid, and commercial insurance billing processes.
• Strong organizational skills and attention to detail.
• Excellent communication and interpersonal skills.
• Ability to work independently and as part of a team.
• Proficiency in Microsoft Office Suite (Excel, Word).

Job Type: Full-time

Work Location: In person