physician credentialing specialist

Chord Specialty Dental Partners

<div><div><b>Location: </b>Nashville, TN or West Chester, PA</div><div><b>
Schedule: </b>Monday - Friday 8:00am - 5:00pm</div><div><b>
Pay: </b>$30 - $35 based on experience</div><div></div><div><br>
At <b>Chord Specialty Dental Partners</b>, exceptional patient care starts with the behind-the-scenes work of our Credentialing team. We&rsquo;re looking for a <b>Credentialing Specialist</b> to join our close-knit, collaborative department that plays a vital role in supporting clinical operations and the revenue cycle.</div><div></div><div><br>
This role involves managing initial and ongoing credentialing, maintaining relationships with insurance payers, and working closely with our Revenue Cycle Management team to resolve claims issues. Organization, adaptability, and strong communication skills are key as you help ensure our providers are always ready to deliver care.</div><div></div><div><br>
Our team is the engine that keeps everything moving&mdash;ensuring our doctors are credentialed and ready to deliver care. Your work directly supports our mission to create healthy, confident, and beautiful smiles every day. If you're detail-oriented and thrive in a fast-paced environment, we&rsquo;d love to have you on our team.</div><div></div><ul><li><div><br>
Onboard new providers and ensure all checklist items are completed and up to date</div></li><li><div>
Manage credentialing with assigned payers, including tracking and follow-up</div></li><li><div>
Enroll providers and offices with State Medicaid agencies and insurance companies</div></li><li><div>
Coordinate new office openings and update payer/internal rosters</div></li><li><div>
Maintain accurate credentialing records</div></li><li><div>
Submit specialty contract requests and upload fee schedules</div></li><li><div>
Complete recredentialing every three years and ensure timely submissions</div></li><li><div>
Review and update payer rosters for accuracy</div></li><li><div>
Communicate credentialing updates and special requests to internal teams</div></li><li><div>
Support the development of SOPs and assist the RCM team with credentialing-related issues</div></li></ul><ul><li><div><br>
3&ndash;5 years of credentialing and enrollment experience required</div></li><li><div>
Proficient in Microsoft Office and credentialing databases</div></li><li><div>
Strong time management, multitasking, and organizational skills</div></li><li><div>
Knowledge of administrative processes and business operations</div></li><li><div>
Excellent written communication, grammar, and proofreading skills</div></li><li><div>
Experience producing professional documents and managing information systems</div></li></ul><div><b>
What We Offer</b></div><div>
We believe that taking care of our employees and their families is paramount. That's why we offer a comprehensive benefits package designed to support you in every aspect of your life. Here&rsquo;s what we provide:</div><ul><li><b>
Medical and Vision Insurance</b>: You're eligible starting the first month after you join.</li><li><b>
In-house Dental Coverage</b>: Enjoy this benefit with $0 premium.</li><li><b>
401(k) Plan with Company Match</b>: We help you plan for your future with our matching program.</li><li><b>
Generous Paid Time Off and Holidays</b>: Take the time you need to relax and recharge.</li><li><b>
Employee Referral Program:</b> Earn rewards for bringing talented individuals to our team.</li><li><b>
Big savings, big perks: </b>Enjoy exclusive discounts on everything from restaurants and travel to movies and more with our employee discount program.</li><li><b>
Pet Insurance</b>: We understand the importance of furry family members too.</li><li><b>
Cutting-edge Technology and Training</b>: We provide the tools and resources you need to excel in your role.</li><li><b>
Life and Disability Insurance Options</b>: Protect yourself and your loved ones with our coverage options.</li></ul><div><b>
Who We Are</b></div><div>
At Chord Specialty Dental Partners, our goal is for every employee to cultivate a fulfilling career. From serving patients in one of our many multi-specialty dental practices to serving our Home Office based out of Nashville, TN- we have something for everyone. We&rsquo;re always looking for talented, driven individuals who have a desire to make an impact.</div><div></div><div><br>
#IND</div></div><div></div>

Senior Credentialing Specialist

biniTelecom

<p>Docs RCM LLC is growing, and we are looking for a dedicated Insurance Credentialing Specialist to join our team!</p><ul><li><b>Position:</b> Insurance Credentialing Specialist</li><li><b>Shift:</b> Night Shift</li><li><b>Location:</b> On-Site</li></ul><p>Key Responsibilities</p><ul><li>Provider Credentialing &amp; Insurance Enrollment</li><li>CAQH Profile Creation, Maintenance &amp; Re-attestation</li><li>Collection and Verification of Provider Documents</li><li>Credentialing Application Preparation &amp; Submission</li><li>Regular Follow-up with Insurance Companies</li><li>Recredentialing &amp; Provider Maintenance</li><li>Management of Payer Portals (Commercial, Medicare &amp; Medicaid)</li><li>Credentialing Status Tracking &amp; Reporting</li><li>Ensuring Compliance with Credentialing Requirements</li><li>Preparing Weekly &amp; Monthly Credentialing Reports</li></ul><p>Requirements</p><ul><li>Minimum 1 year of experience in medical insurance credentialing</li><li>Excellent verbal and written communication skills</li><li>Strong organizational skills with attention to detail</li><li>Ability to work independently and manage multiple credentialing applications</li><li>Willingness to work night shifts</li></ul><p>What We Offer</p><ul><li>Competitive &amp; Lucrative Salary</li><li>Bi-Annual Performance-Based Salary Increments</li><li>Pick &amp; Drop Facility for Female Employees</li><li>Professional, Friendly &amp; Supportive Work Environment</li><li>Career Growth &amp; Learning Opportunities</li></ul><p>If you are passionate about healthcare administration and want to build your career with a fast-growing Revenue Cycle Management company, we would love to hear from you!</p><p>Apply today and become a valued member of the Docs RCM LLC team!</p><p>Pay: Rs60,000.00 - Rs80,000.00 per month</p><p>Work Location: In person</p>

Insurance Credentialing Specialist - Medical Billing - Night Shift

RCM360

<p><b>About RCM360</b></p><p>RCM360 is a healthcare revenue cycle management organization specializing in medical billing, credentialing, coding, accounts receivable management, and practice optimization services. We partner with healthcare providers across the United States to improve reimbursement, streamline operations, and support long-term financial success.</p><p><b>Position Summary</b></p><p>RCM360 is seeking an experienced and highly organized Provider Enrollment and Credentialing Specialist to support credentialing and enrollment activities for medical providers and healthcare organizations. The Credentialing Specialist will be responsible for managing provider enrollment, recredentialing, payer audits, and maintaining provider data across multiple platforms while ensuring compliance with payer, regulatory, and organizational requirements.</p><p>The ideal candidate will have strong knowledge of Medicare, Medicaid, commercial payer credentialing, and provider enrollment processes, along with the ability to manage multiple projects and deadlines in a fast-paced environment.</p><p><b>Primary Responsibilities</b></p><ul><li>Complete provider credentialing and recredentialing applications for commercial, Medicare, Medicaid, and managed care payers.</li><li>Process provider enrollment, revalidation, and demographic updates with government and commercial payers.</li><li>Maintain accurate provider information in CAQH, PECOS, NPPES, and payer portals.</li><li>Monitor credentialing status and proactively follow up with payers to ensure timely approvals.</li><li>Maintain detailed documentation of credentialing activities within credentialing software and tracking systems.</li><li>Coordinate initial credentialing and ongoing recredentialing with hospitals, surgery centers, and ancillary facilities.</li><li>Verify provider licenses, board certifications, DEA registrations, malpractice insurance, and other required credentials.</li><li>Respond to payer requests for additional documentation and resolve enrollment issues.</li><li>Collaborate with billing, coding, and account management teams to address denials or reimbursement issues related to credentialing.</li><li>Participate in client meetings and provide status updates regarding credentialing projects.</li><li>Stay current with payer guidelines, enrollment requirements, and industry regulations.</li><li>Assist with onboarding new providers and ensure credentialing tasks are completed prior to effective dates.</li><li>Maintain confidentiality and compliance with HIPAA and company policies.</li></ul><p><b>Skills &amp; Abilities</b></p><p><b>General</b></p><ul><li>Excellent written and verbal communication skills.</li><li>Strong attention to detail and organizational abilities.</li><li>Ability to manage multiple provider enrollments simultaneously.</li><li>Professional demeanor with strong customer-service orientation.</li><li>Ability to work independently and as part of a team.</li><li>Proficiency with Microsoft Office applications and credentialing software platforms.</li></ul><p><b>Problem Solving</b></p><ul><li>Identifies and resolves credentialing issues efficiently.</li><li>Research complex payer requirements and enrollment challenges.</li><li>Escalates issues appropriately while maintaining ownership of assigned projects.</li></ul><p><b>Project Management</b></p><ul><li>Tracks multiple credentialing projects and deadlines simultaneously.</li><li>Provides timely updates to clients and internal stakeholders.</li><li>Maintains accurate reporting and documentation.</li></ul><p><b>Preferred Experience</b></p><ul><li>Experience with CAQH, PECOS, NPPES, and Medicare enrollment processes.</li><li>Experience working within a Revenue Cycle Management organization.</li><li>Experience with credentialing software platforms.</li><li>Experience working with offshore teams is a plus.</li><li>Familiarity with eClinicalWorks and NextGen healthcare practice management systems is a plus.</li></ul><p><b>Qualifications</b></p><ul><li><b>Minimum 2 years of medical credentialing experience required.</b></li><li>Demonstrated experience credentialing providers with Medicare, Medicaid, and commercial insurance payers.</li><li>Strong understanding of provider enrollment, recredentialing, and payer maintenance processes.</li><li>High school diploma required</li><li>Credentialing certification (CPCS, CPMSM, or equivalent) preferred but not required.</li></ul><p><b>Job Details</b></p><ul><li>Full-Time</li><li>Remote</li><li>Occasional travel as required for client meetings or training</li></ul><p><b>Key Performance Metrics</b></p><ul><li>Credentialing applications submitted accurately and on time</li><li>Recredentialing projects completed before payer deadlines</li><li>Provider enrollment turnaround times</li><li>Accuracy of provider records and databases</li><li>Client satisfaction and responsiveness</li><li>Productivity and quality standards achieved</li></ul><p>Pay: $45,000.00 - $55,000.00 per year</p><p>Benefits:</p><ul><li>401(k)</li><li>401(k) matching</li><li>Dental insurance</li><li>Flexible spending account</li><li>Health insurance</li><li>Health savings account</li><li>Life insurance</li><li>Paid time off</li><li>Vision insurance</li></ul><p>Work Location: Remote</p>

Provider Enrollment and Credentialing Specialist

CommUnityCare Health Centers

<div>Overview:
<div>
In collaboration with patients, families (as defined by the patient) and staff across all disciplines and departments is responsible for providing direct and appropriate clinical care and treatment to patients in the area of clinical specialization under the direct supervision and responsibility of a physician.</div><br>
<div></div>
Responsibilities:
<div>
ESSENTIAL/PRIMARY DUTIES<br>
<ul><li>Perform comprehensive physical assessment of patients using observation, inspection, auscultation, palpation and percussion.</li><li>Order or execute various tests, analyses, and diagnostic images to provide information on patient&rsquo;s condition.
</li><li>Diagnose and treat diseases, disorders and injuries based on patient&rsquo;s medical history and results of physical assessment and refer patients to medical specialist or other practitioner for specialized treatment.</li><li>Prescribe medications and therapies for treatment and preventive care.
</li><li>Instruct patients and their families regarding procedures performed, home care, and follow-up visits.
</li><li>Direct professional and ancillary health care staff during treatment of patients.
</li><li>Respond to inquiries from staff and patients regarding preventive health and treatments.
</li><li>Compile patient medical data including health history, treatment plans, results of physical examination, etc. and record in electronic medical record.</li><li>Report required information including deaths and outbreak of contagious diseases to governmental authorities.</li><li>Plan, promote, demonstrate, recommend and coordinate high standards of medical practice.
</li><li>Demonstrated expertise in relevant medical practices, protocol, trends and best practices in clinical areas assigned.
</li><li>Demonstrated knowledge and success in effecting overall clinical operations.
</li><li>Proficiency in the use of a computer, software packages, and office machines.</li><li>Work within the scope of credentialing privileges.
</li><li>Perform other duties as assigned.</li></ul></div><div>
Knowledge/Skills/Abilities:<br>
<ul><li>High level of skill at building relationships and providing excellent customer service.</li><li>Interpersonal savvy and influence skills in managing difficult clients and patients.
</li><li>High degree of knowledge and competency in the practice of medicine and associated charting requirements.
</li><li>Requisite skills and ability to perform certain medical tasks as assigned.</li><li>High level of problem solving skill to better serve patients and staff.</li><li>Strong attention to detail and accuracy.</li><li>Ability to utilize computers for data entry and information retrieval.</li><li>Ability to manage multiple responsibilities and emergency situations successfully.
</li><li>Excellent verbal and written communication skills.</li><li>Ability to implement, and evaluate operational and administrative processes.</li><li>Experience/knowledge of Joint Commission accreditation process and requirements, as well as all federal, state and local regulations and standards associated with the delivery of care in a Federally Qualified Health Center.</li><li>Demonstrated understanding and/or experience working in a patient-centered medical home (PCMH) environment.</li><li>Demonstrated understanding and/or experience working in an integrated delivery environment.</li></ul></div><div>
Qualifications:<br>
<ul><li>Directly affect improvements in patient well-being through accurate and timely diagnosis and delivery of relevant, high quality medical care.
</li><li>Ensure all tasks provided and associated with patient care, patient administrative processes and related duties comply with all regulatory and accreditation standards including The Joint Commission and CommUnityCare Standard Operating Procedures and CommUnityCare Policies and Procedures.</li><li>Develop and maintain favorable internal relationships, partnerships with co-workers, including clinical managers, clinical support staff, providers and business office staff.</li><li>Interact respectfully and collaboratively with patients and their families, striving to develop favorable relationships with families.</li><li>Collaborate with all members of the care team in providing patient-centered care.</li><li>Ensure all actions, job performance, personal conduct and communications represent CommUnityCare in a highly professional manner at all times.</li><li>Uphold and ensure compliance and attention to all company policies and procedures as well as the overall mission and values of the organization.</li><li>Complete all mandatory training and maintain appropriate credentials/licensure.</li></ul></div><br>
<div></div>
Qualifications:
<div>
MINIMUM EDUCATION:
<br>
Graduation from an accredited School of Physician Assistants OR Master&rsquo;s degree from an accredited School of Nursing.</div><div><br>
REQUIRED CERTIFICATIONS/LICENSURE:
<br>
<ul><li>Unrestricted license to practice as a Physician Assistant in the State of Texas OR unrestricted license to practice Nursing in the State of Texas/current credentialing as an Advanced Nurse Practitioner by the Texas Board of Nurse Examiners.</li><li>Current certification in area of specialty.</li><li>Current Drug Enforcement Agency (DEA) for the purpose of writing prescriptions.</li><li>Current Healthcare Provider Cardiopulmonary Resuscitation (CPR) through American Heart Association.</li><li>Current Basic Life Support Certification for Healthcare Providers through American Heart Association.</li></ul></div></div><div></div>

Advanced Practice Provider- Women's Health

Henry Ford Health

<div><div><p>Nurse Practitioner / Physician Assistant | West Bloomfield | Orthopedic Surgery | Contingent | Days</p><p></p><p><b><br>
Location:</b> Henry Ford West Bloomfield</p><p><b>
Status:</b> Contingent | Days</p><p><b>
Setting:</b> 100% Inpatient | 100% Adult</p><p><b>
Call/Weekends:</b> No call requirements, 1 weekend per month</p><p></p><p><b><br>
Position Overview:</b></p><p></p><p><b><br>
Henry Ford Health System </b>is seeking a Contingent<b> Nurse Practitioner or Physician Assistant </b>to join our<b> Orthopedic Surgery </b>team in <b>West Bloomfield, MI.</b> This role provides comprehensive inpatient orthopedic surgery care at Henry Ford Health. The Advanced Practice Provider will serve as a first-line provider, responsible for the assessment, diagnosis, treatment, education, consultation, and care coordination of orthopedic surgery patients and their families. Working collaboratively with attending physicians, advanced practice providers, consultants, house officers, nurses, and other members of the interdisciplinary care team, the APP will help ensure safe, efficient, and high-quality patient care. Responsibilities include assisting in the operating room and performing procedures consistent with credentialing, training, and experience.</p><p></p><p><b><br>
Why Henry Ford Health</b></p><ul><li>
Competitive salary and comprehensive benefits</li><li>
Opportunities for professional development and continuing education.</li><li>
Supportive, collaborative systemwide team</li><li>
Meaningful impact on employee health and safety</li></ul><p></p><p><i><br>
Employment contingent upon credentialing and completion of Employee Health screening per HFHS policy.</i></p><br>
<p></p>
<div><p><b>Qualifications:</b></p><br>
<p></p><ul><li>
2 years of surgery experience as an APP required</li><li>
NP or PA graduate from an accredited program</li><li>
Current (or in-process) Michigan licensure</li><li>
National certification (ANCC, AANP, or NCCPA)</li><li>
BLS required; ACLS required</li></ul><p></p><p><b><br>
Credentials:</b></p><p></p><p><b><br>
Education &amp; Training</b></p><ul><li> <b>Physician Assistant (PA):</b> Completion of a Physician Assistant program accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA)</li><li> <b>Nurse Practitioner (NP):</b> Completion of a Nurse Practitioner program accredited by the Commission on Collegiate Nursing Education (CCNE) or the National League for Nursing Accrediting Commission (NLNAC)</li></ul><p></p><p><b><br>
Licensure</b></p><ul><li> <b>Current licensure</b> as a Physician Assistant, Nurse Practitioner in the State of Michigan, or in the process of applying (proof of application required).</li></ul><p></p><p><b><br>
Certification</b></p><ul><li> <b>PA:</b> Certification by the <b>National Commission on Certification of Physician Assistants (NCCPA)</b></li><li> <b>NP:</b> National certification by a certification body recognized by the State of Michigan</li></ul><p>
(e.g., ANCC, AANP)</p><p></p><p><b><br>
Required Certifications</b></p><ul><li><b>
Basic Life Support (BLS)</b> &ndash; required</li><li><b>
Advanced Cardiovascular Life Support (ACLS)</b> &ndash; required (may be obtained after hire)</li></ul><p><b>
DEA / Controlled Substance Licensure</b></p><ul><li><b>
PA:</b> DEA and Michigan Controlled Substance License (CSL) required through credentialing</li><li><b>
NP:</b> DEA registration required through credentialing; NPs do not hold a Michigan CSL and will use their Michigan license number during the application process</li></ul><br>
<p></p>
</div><div>Additional Information
</div><ul><li>Organization: Henry Ford West Bloomfield Hospital</li>
<li>Department: HFWB APP - Orthopedic Surgery</li>
<li>Shift: Day Job</li>
<li>Union Code: Not Applicable</li>
 </ul></div><div><div><div><div><h4 class="jobSectionHeader"><b>Additional Details</b></h4>
<div><p>
This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above.</p></div>
</div>
</div></div><div><div><div><h4 class="jobSectionHeader"><b>Overview</b></h4>
<div><p>
Henry Ford Health partners with millions of people on their health journey, across Michigan and around the world. We offer a full continuum of services &ndash; from primary and preventative care to complex and specialty care, health insurance, a full suite of home health offerings, virtual care, pharmacy, eye care and other health care retail. With former Ascension southeast Michigan and Flint region locations now part of our team, Henry Ford&rsquo;s care is available in 13 hospitals and hundreds of ambulatory care locations. Based in Detroit, Henry Ford is one of the nation&rsquo;s most respected academic medical centers and is leading the Future of Health: Detroit, a $3 billion investment anchored by a reimagined Henry Ford academic healthcare campus. Learn more at henryford.com/careers.</p></div>
</div>
</div></div><div><div><div><h4 class="jobSectionHeader"><b>Benefits</b></h4><div><p><br>
</p><p>The health and overall well-being of our team members is our priority. That&rsquo;s why we offer support in the various components of our team&rsquo;s well-being: physical, emotional, social, financial and spiritual. Our Total Rewards program includes competitive health plan options, with three consumer-driven health plans (CDHPs), a PPO plan and an HMO plan. Our team members enjoy a number of additional benefits, ranging from dental and eye care coverage to tuition assistance, family forming benefits, discounts to dozens of businesses and more. Employees classified as contingent status are not eligible for benefits.
</p></div></div></div></div><div><div><div><h4 class="jobSectionHeader"><b>Equal Employment Opportunity/Affirmative Action Employer</b></h4>
<div><p>
 Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health is</p>
<p>
 committed to the hiring, advancement and fair treatment of all individuals without regard to</p>
<p>
 race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height,</p>
<p>
 weight, marital status, family status, gender identity, sexual orientation, and genetic information,</p>
<p>
 or any other protected status in accordance with applicable federal and state laws.</p></div></div></div></div></div></div>

Nurse Practitioner / Physician Assistant | West Bloomfield | Orthopedic Surgery | Contingent | Days

Lighthouse Psychiatry Brain Health Center

<div>
 <strong>
  Virtual Assistant (VA) &ndash; Medical Billing / Credentialing (Psychiatry).
  <br/>
  <br/>
 </strong>
 <strong>
  Company:
 </strong>
 <strong>
  Lighthouse Psychiatry | Arizona.
  <br/>
  <br/>
 </strong>
 <strong>
  Location:
 </strong>
 Remote (US, Philippines, Vietnam, India, Mexico).
 <br/>
 <br/>
 <strong>
  Job Type:
 </strong>
 Full-time / Part-time (Night Shift / U.S. Business Hours).
 <br/>
 <br/>
 <strong>
  Industry:
 </strong>
 Healthcare / Medical Billing / Behavioral Health.
 <br/>
 <br/>
 <strong>
  Hire Model:
 </strong>
 Direct hire (Contract).
 <br/>
 <br/>
 <strong>
  Pay:
 </strong>
 Based on level of experience (opportunity for growth).
 <br/>
 <br/>
 <strong>
  Position Summary
  <br/>
  <br/>
 </strong>
 Lighthouse Psychiatry is seeking a highly organized Medical Billing &amp; Credentialing Specialist responsible for managing the revenue cycle from patient eligibility through claim resolution while ensuring providers remain properly credentialed with commercial and government payers. This role is essential to maximizing reimbursement, maintaining payer compliance, and supporting the growth of our outpatient psychiatry, TMS, Spravato, IV ketamine, and psychotherapy programs.
 <br/>
 <br/>
 The ideal candidate has experience with psychiatric billing, athenaOne, insurance credentialing, and payer relations, with the ability to work independently while maintaining exceptional attention to detail.
 <br/>
 <br/>
 <strong>
  Primary Medical Billing &amp; Revenue Cycle Responsibilities
  <br/>
  <br/>
 </strong>
 <strong>
  Patient Registration &amp; Front-End Revenue Cycle:
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Verify insurance eligibility and benefits.
  </li>
  <li>
   Update insurance information and demographics.
  </li>
  <li>
   Review appointment schedules for insurance issues.
  </li>
  <li>
   Identify authorization requirements.
  </li>
  <li>
   Resolve registration and eligibility errors.
  </li>
  <li>
   Manage insurance verification work queues.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Charge Capture
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Review encounters for billing completeness.
  </li>
  <li>
   Enter charges accurately.
  </li>
  <li>
   Validate CPT and ICD-10 coding consistency.
  </li>
  <li>
   Identify missing documentation.
  </li>
  <li>
   Process no-show billing when applicable.
  </li>
  <li>
   Upload supporting documentation.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Claims Management
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Submit electronic claims.
  </li>
  <li>
   Correct claim edits.
  </li>
  <li>
   Monitor claim acceptance.
  </li>
  <li>
   Review claim history.
  </li>
  <li>
   Submit corrected claims.
  </li>
  <li>
   Process secondary claims.
  </li>
  <li>
   Coordinate benefits (COB).
  </li>
  <li>
   Monitor telehealth claims.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Accounts Receivable
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Follow up on unpaid claims.
  </li>
  <li>
   Investigate denied claims.
  </li>
  <li>
   Resolve payer edits.
  </li>
  <li>
   Prepare appeals.
  </li>
  <li>
   Monitor aging reports.
  </li>
  <li>
   Review payment variances.
  </li>
  <li>
   Research patient accounts.
  </li>
  <li>
   Process insurance corrections.
  </li>
  <li>
   Manage collection worklists.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Payment Posting
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Post insurance payments.
  </li>
  <li>
   Post patient payments.
  </li>
  <li>
   Process credit card transactions.
  </li>
  <li>
   Interpret EOBs and ERAs.
  </li>
  <li>
   Resolve payment discrepancies.
  </li>
  <li>
   Review credit balances.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Specialty Psychiatry Billing
  <br/>
  <br/>
 </strong>
 Independently manage billing for:
 <br/>
 <br/>
 <ul>
  <li>
   Medication Management.
  </li>
  <li>
   Psychiatric Evaluations (90791/90792).
  </li>
  <li>
   Psychotherapy.
  </li>
  <li>
   Add-on psychotherapy codes.
  </li>
  <li>
   Telepsychiatry.
  </li>
  <li>
   TMS.
  </li>
  <li>
   Spravato.
  </li>
  <li>
   IV Ketamine.
  </li>
  <li>
   Urine Drug Screening.
  </li>
  <li>
   Prior Authorizations.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Credentialing Responsibilities (if Applicable)
  <br/>
  <br/>
 </strong>
 Manage the credentialing lifecycle for psychiatrists, psychiatric nurse practitioners, psychologists, therapists, and other clinical staff.
 <br/>
 <br/>
 <strong>
  Responsibilities Include
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Complete initial payer enrollment applications.
  </li>
  <li>
   Process provider recredentialing.
  </li>
  <li>
   Maintain CAQH profiles.
  </li>
  <li>
   Track provider license expiration.
  </li>
  <li>
   Monitor DEA registrations.
  </li>
  <li>
   Track board certifications.
  </li>
  <li>
   Monitor malpractice insurance expiration.
  </li>
  <li>
   Maintain provider credentialing files.
  </li>
  <li>
   Submit supporting documentation.
  </li>
  <li>
   Communicate with insurance companies.
  </li>
  <li>
   Track credentialing status.
  </li>
  <li>
   Maintain provider rosters.
  </li>
  <li>
   Complete demographic updates.
  </li>
  <li>
   Assist with new provider onboarding.
  </li>
  <li>
   Ensure compliance with payer requirements.
  </li>
  <li>
   Monitor participation status.
  </li>
  <li>
   Maintain provider directories.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Required Knowledge
  <br/>
  <br/>
 </strong>
 Strong understanding of:
 <br/>
 <br/>
 <ul>
  <li>
   CPT coding.
  </li>
  <li>
   ICD-10 diagnosis coding.
  </li>
  <li>
   Medical terminology.
  </li>
  <li>
   HIPAA regulations.
  </li>
  <li>
   EOB interpretation.
  </li>
  <li>
   Revenue Cycle Management.
  </li>
  <li>
   Insurance eligibility.
  </li>
  <li>
   Claim adjudication.
  </li>
  <li>
   Prior authorization requirements.
  </li>
  <li>
   Coordination of Benefits (COB).
  </li>
  <li>
   Medicare billing.
  </li>
  <li>
   AHCCCS billing.
  </li>
  <li>
   Commercial insurance billing.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Qualifications
  <br/>
  <br/>
 </strong>
 <strong>
  Required:
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   2+ years of medical billing experience.
  </li>
  <li>
   1+ year of insurance credentialing experience.
  </li>
  <li>
   Experience with commercial insurance and Medicare.
  </li>
  <li>
   Strong computer proficiency.
  </li>
  <li>
   Excellent organizational skills.
  </li>
  <li>
   Ability to manage multiple deadlines.
  </li>
  <li>
   Strong written and verbal communication.
  </li>
  <li>
   Clean claim rate high.
  </li>
  <li>
   First-pass claim acceptance rate high.
  </li>
  <li>
   Payment posting accuracy.
  </li>
  <li>
   Work queue completion rate high.
  </li>
  <li>
   Productivity standards high.
  </li>
  <li>
   Documentation accuracy high.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Preferred
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Behavioral health or psychiatry billing experience.
  </li>
  <li>
   athenaOne experience.
  </li>
  <li>
   AHCCCS experience.
  </li>
  <li>
   CPC, CPB, or equivalent certification.
  </li>
  <li>
   Credentialing experience with multi-provider practices.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Ideal Candidate
  <br/>
  <br/>
 </strong>
 The ideal candidate is detail-oriented, analytical, and proactive, with the ability to independently manage both revenue cycle operations and provider credentialing. They thrive in a fast-paced outpatient behavioral health environment and are committed to improving reimbursement, reducing denials, and ensuring uninterrupted payer participation for providers.
 <br/>
 <br/>
 This job description aligns closely with the competency framework in your Billing Skills Tracker while converting it into a market-ready hiring document suitable for Indeed, LinkedIn, or internal HR use. It is particularly tailored for an Arizona psychiatry practice using athenaOne and managing commercial insurance, Medicare, and AHCCCS.
 <br/>
 <br/>
 <strong>
  Keywords
  <br/>
  <br/>
 </strong>
 Virtual Assistant, Healthcare Virtual Assistant, Medical Billing VA, Insurance Verification VA, Prior Authorization VA, Telehealth VA, Revenue Cycle Assistant, Medical Billing, Claims Processing, Insurance Verification, Prior Authorization, Revenue Cycle Management (RCM), Denial Management, EOB Reconciliation, Patient Intake, Appointment Scheduling, Data Entry, HIPAA Compliance, EMR/HER, CPT Codes, ICD-10, HCPCS, Claims Submission, Eligibility Checking, Payer Portals, Medical Coding, Billing Software, Athena, DrChrono, Kareo, AdvancedMD, Epic, Practice Fusion, Behavioral Health, Psychiatry, Mental Health, Telemedicine, Telehealth, Healthcare Administration, Patient Access, Front-End Billing, Back-End Billing, Remote, Philippines, Night Shift, Offshore Healthcare, Home-Based, Virtual Office.
</div>


Virtual Assistant - Medical Billing/Credentialing

Nicklaus Children's Health System

<div><h2 class="jobSectionHeader"><div><b>Description</b></div></h2><p><b>
Job Summary</b></p><p>
Primary responsibility in association with the attending physician(s), for the management of Pediatric Hospital Medicine patients within the Clinical Observation Unit (COU) inclusive of patients admitted under Pediatric Hospital Medicine observation status to other areas of the hospital should the COU be at maximum capacity. Participates in pediatric patient's clinical care demonstrating high levels of critical thinking skills as a member of an interdisciplinary team. Responsibilities include completing history and physical examinations, ordering and interpreting radiological and laboratory test results, prescribing medications, documenting patient care services within EMR and departmental records, and performing within scope of practice and demonstrated competency.</p><p><b>
Job Specific Duties</b></p><ul><li>
Conducts medical rounds, oversees and documents plan in collaboration with the attending physician. Performs comprehensive assessments and provides accurate documentation. Ensure plan of care for the hospitalized patient is of sufficient quality and depth to guide the team in achieving the desired outcome.
</li><li>Ensures proper communication between physicians and families. Serves as an advocate and educator and provides families with support and community resources.
</li><li>Maintains a high level of critical thinking and time management skills. Completes clinical documentation accurately and in a timely manner of 24 hours.
</li><li>Contributes to the development of peers, colleagues, and others to improve patient outcomes and to promote growth of the nursing profession by facilitating collaboration and communication.
</li><li>Ensures understanding and skills necessary to provide care appropriate to the developmental level of the patient.</li><li>
Generates, collects, and integrates data from a wide variety of sources in order to make clinical judgments and decisions about the initiation of orders, procedures, referrals, and treatments.</li><li>
Accountable for maintaining current expertise and skills in order to facilitate a high quality of clinical performance and to promote professional growth.
</li><li>Models professional verbal and written communication with the interdisciplinary team members involved in the ongoing management of patients to optimize patient outcomes.
</li><li>Participates in other necessary activities associated with patient care (writing daily progress notes, coordinating clinical care, discharge planning, etc.).
</li><li>Writes orders, monitors/alters drug therapies, and performs other procedures with education and experience within established protocol in collaborative relationship with a physician(s).
</li><li>Works variable shifts, nights, weekends and holidays.
</li></ul><p>#APP</p><h2 class="jobSectionHeader"><div><b>
Qualifications</b></div></h2><p><b>
Minimum Job Requirements</b></p><ul><li>
Master's degree in nursing or Doctor of Nursing Practice (DNP) from an accredited school</li><li>
Valid State of Florida APRN License-maintain active and in good standing throughout employment</li><li>
FNP or PNP Certification by the American Nurse Credentialing Center (ANCC), American Academy of Nurse Practitioner Certification Program (AANP), or Pediatric Nursing Certification Board (PNCB)-maintain active and in good standing throughout employment</li><li>
American Heart Association PALS - maintain active and in good standing throughout employment</li><li>
American Heart Association BLS - maintain active and in good standing throughout employment</li><li>
Successful completion of Credentialing by NCHS Medical Administration required</li><li>
Level II Background Check</li></ul><p><b>
Knowledge, Skills, and Abilities</b></p><ul><li>
Acute Care Pediatric Nurse Practitioner Certification preferred.</li><li>
Able to relate cooperatively and constructively with patients, families, and co-workers.</li><li>
Able to work independently and collaboratively with other disciplines using discretion and independent judgement.</li><li>
Able to maintain confidentiality of sensitive information.</li><li>
Ability to problem-solve to formulate a plan of care and evaluate the patient's response to care.</li><li>
Ability to interpret, adapt and react calmly under stressful conditions.</li><li>
Strong interpersonal, communication, collaboration, and conflict resolution skills</li><li>
Ability to apply principles of evidence-based practice, analytical thinking, and service excellence in practice.</li></ul><p>
As required under the directive of House Bill 531 (2025) we are providing the link below to the Care Provider Background Screening Clearinghouse Education and Awareness website.</p><p><b>
https://info.flclearinghouse.com/</b></p><p></p><p><br>
#APP</p><h2 class="jobSectionHeader"><div><b><br>
Job:</b></div></h2>
Nursing - Clinical<br>
<h2 class="jobSectionHeader"><div><b>
Department:</b></div></h2>
NCPS-HOSPITALIST-3100-468804<br>
<h2 class="jobSectionHeader"><div><b>
Job Status:</b></div></h2>
Professional</div>

Advanced Practice Provider – Hospitalist (Part Time, Days)

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