Credentialing and Medical Billing Specialist | WFH

Position Summary:

We are seeking a highly skilled and adaptable professional to join our team in a hybrid role that combinesCredentialingandMedical Billingresponsibilities. This position will primarily focus on credentialing tasks across various clients but will also support medical billing projects as they arise. The ideal candidate has multiple years of experience in either credentialing, medical billing, or both. Credentialing experience in multiple states or medical billing experience across multiple EMR systems is a plus.This role is perfect for someone who thrives in a dynamic environment, can easily jump into diverse client projects, and is eager to expand their skill set.

Job Details:

• Credentialing and Medical Billing Specialist
• Permanent work from home
• Following US Holidays
• Monday to Friday 7:00 AM 4:00 PM Pacific Time/ 11:00 PM to 8:00 AM Manila Time

Responsibilities:

Credentialing

• Complete and submit credentialing applications with supporting documentation to commercial payers.
• Monitor application progress/status and follow up with payers until the credentialing process is complete and the provider is in network. Update logs as necessary.
• Communicate with and notify staff of any missing or expired documentation.
• Update and re-attest (as necessary) provider credentials through CAQH, Availity, UnitedHealthcare, and other portals.

Medical Billing

• Monitor the status of medical claims to ensure prompt and accurate payment.
• Research and resolve claim rejections and denials, implementing measures to prevent future occurrences.
• Document all account activities accurately and in a timely manner.
• Post adjustments and manage collections from various types of payers.
• Understand and apply Medicare, Medicaid, and commercial insurance eligibility requirements and payment methodologies.
• Correctly record contractual adjustments based on payer contracts and government regulations.
• Exhibit proficiency with billing systems and leverage all functionality to ensure the most efficient processing of claims.
• Call payers to get updates on claims and discuss the resolution of rejected claims.
• Answer patient questions about claims (where applicable.)
• Maintain up-to-date knowledge of changes in billing and coding guidelines, payer contracts, and government regulations.
• Collaborate with team members and providers, fostering a positive and productive work environment.

Qualifications:

• Minimum 5 years of hands-on experience in medical billing, with exposure to various EMR/EHR systems (e.g., Athena, Apero, etc.) OR Minimum 3 years of credentialing experience for US providers.
• Proven ability to work independently across different client environments and adapt quickly to new systems and workflows
• Strong understanding of medical billing procedures, insurance eligibility, payer requirements (Medicare, Medicaid, commercial), and denial resolution.
• Exceptional attention to detail and accuracy, especially for documentation and data entry.
• Strong organizational and project management skills; able to manage multiple credentialing and billing projects simultaneously.
• Effective written and verbal communication skills, including professional interaction with payers, providers, and patients.
• Willingness to learn and perform credentialing responsibilities in addition to medical billing duties.