Billing and Credentialing Specialist

Job Summary

Seeking Billing and Credentialing Specialist to join our team! Responsible for credentialing new and current providers with Medicare, Medi-Cal and all other Insurance Plans, assisting with billing functions to obtain revenue and payment including maintaining account receivable reports according to our policy and procedure manual.

Responsibilities:

• Follow up on unpaid or denied claims, identifying and resolving billing discrepancies.
• Collaborate with healthcare providers, administrators, and insurance companies to obtain necessary documentation and resolve billing-related inquiries.
• Keep up-to-date with insurance policies, billing codes, and regulatory requirements to ensure compliance and accurate billing practices.
• Maintain and update provider credentialing records, ensuring compliance with credentialing guidelines and contract requirements.
• Process and submit provider credentialing applications to insurance companies, government agencies, and other relevant entities.
• Monitor provider enrollment status, track expiring credentials, and initiate the re-credentialing process as needed.
• Maintain a centralized database of provider credentialing information, ensuring confidentiality and accuracy.
• Collaborate with internal teams, such as billing, finance, and operations, to streamline processes and improve billing and credentialing efficiency.
• Stay informed about changes in billing and credentialing regulations, attending training sessions and conferences as necessary.

Qualifications:

• Previous experience in medical billing and credentialing is required.
• Strong knowledge of medical billing procedures, including coding, claims submission, and reimbursement processes.
• Familiarity with insurance plans, including Medicare, Medicaid, and commercial payers.
• Proficiency in using medical billing software and electronic health records (EHR) systems.
• Understanding of medical terminology, CPT codes, ICD-10 codes, and billing modifiers.
• Excellent attention to detail and accuracy in handling billing and credentialing processes.
• Strong problem-solving and analytical skills to identify and resolve billing discrepancies.
• Effective communication skills, both written and verbal, to interact with providers, insurance companies, and internal stakeholders.
• Ability to work independently, prioritize tasks, and meet deadlines in a fast-paced healthcare environment.
• Knowledge of credentialing processes, provider enrollment, and re-credentialing requirements.
• Familiarity with credentialing software and databases is a plus.
• Knowledge of HIPAA regulations and compliance standards.
• Strong organizational skills and ability to maintain confidential information.

Experience:

Minimum Experience Required: 2 years medical and institutional billing and accounts receivable. Knowledge of CPT codes and Medicare

Qualifications:

• High school diploma or equivalent is required.
• Additional education or certification in medical billing and/or credentialing is preferred.
• Must be able to pass all background checks

What We Offer:

• Monday - Friday schedule, no weekends
• 401(k) Retirement Plan (with employer match)
• Internal ongoing educational/training opportunities
• Competitive compensation
• Continuous coaching & mentorship

When you join our team, you have the opportunity to develop your career based on your strengths and potential, including the possibility to move functionally, geographically, laterally and vertically. This is a career destination for engaged, caring, passionate and talented people who want to make a difference. We are the leader in the development and management of comprehensive wound healing.

Equal Opportunity Employer encouraging diversity in the workplace. All qualified applicants will receive consideration for employment without regard to race, national origin, gender, age, religion, disability, sexual orientation, veteran status or marital status.