Medical Billing, Collections & Credentialing Specialist

We are seeking a highly organized and experienced Medical Billing, Collections & Credentialing Specialist to join our growing behavioral health practice. This role is responsible for maximizing revenue through accurate medical billing, proactive insurance follow-up, ethical collection efforts, and provider credentialing with commercial and government payers.

The ideal candidate has strong knowledge of the entire revenue cycle, including claims management, payment posting, denial resolution, patient collections, and provider enrollment. This individual will serve as a liaison between providers, patients, insurance carriers, and credentialing organizations while ensuring compliance with payer requirements and applicable regulations.

Overview of Job Functions and Duties

Medical Billing & Revenue Cycle

• Prepare, review, and submit clean electronic and paper claims to commercial and government payers.
• Review daily billing to ensure timely claim submission through the clearinghouse.
• Audit patient charges to verify coding accuracy and compliance with provider documentation.
• Monitor claim status and resolve claim rejections, edits, and denials.
• Submit corrected claims, reconsiderations, and formal appeals as necessary.
• Post insurance payments, patient payments, adjustments, and contractual write-offs accurately.
• Reconcile payments and identify reimbursement discrepancies.
• Verify insurance eligibility and benefits when necessary.
• Maintain accurate patient account documentation within the practice management system.
• Ensure all billing activities comply with payer guidelines, HIPAA, and applicable regulations.

Insurance Follow-Up & Collections

• Perform timely follow-up with insurance carriers via phone, online portals, and written correspondence.
• Research and resolve unpaid, underpaid, and denied claims.
• Monitor accounts receivable and aging reports to improve collection performance.
• Contact patients regarding outstanding balances while maintaining professionalism and compliance with debt collection regulations.
• Collect co-payments, deductibles, coinsurance, and no-show fees.
• Send patient statements and explanatory correspondence regarding balances.
• Resolve patient billing inquiries and payment disputes.
• Recommend accounts for payment plans, collections, or management review when appropriate.

Provider Credentialing & Enrollment

• Complete and submit provider credentialing and recredentialing applications.
• Maintain CAQH profiles and ensure provider information remains current and accurate.
• Enroll providers with commercial insurance plans, Medicare, Medicaid, and other payer networks.
• Track credentialing applications from submission through approval.
• Maintain provider licenses, DEA registrations, malpractice insurance, board certifications, and other required documentation.
• Monitor credentialing expiration dates and initiate renewals before deadlines.
• Work directly with payer representatives to resolve credentialing and enrollment issues.
• Maintain credentialing records and reports for management.

Reporting & Administrative Responsibilities

• Perform daily, weekly, and monthly revenue cycle reconciliation and closing procedures.
• Generate billing, collections, aging, and credentialing status reports.
• Identify trends in denials and reimbursement issues and recommend process improvements.
• Maintain confidentiality of patient information and adhere to HIPAA requirements.
• Collaborate with providers, front office staff, and management to improve reimbursement and operational efficiency.
• Perform additional duties as assigned by management.

Qualifications
Education

• Medical Billing and Coding Certificate, CPC, Certified Professional Biller (CPB), Certified Revenue Cycle Representative (CRCR), or equivalent certification preferred.

Experience

• 3–5 years of medical billing, collections, and insurance follow-up experience required.
• 2+ years of provider credentialing and payer enrollment experience preferred.
• Behavioral health or psychiatry billing experience strongly preferred.
• Experience with Medicare, Medicaid, and commercial insurance plans.
• Experience using electronic health records (EHR) and practice management systems.
• Knowledge of clearinghouses, claim editing, appeals, and revenue cycle management.
• Strong understanding of HIPAA, payer regulations, and insurance billing guidelines.

Skills

• Excellent organizational and time management skills.
• Strong analytical and problem-solving abilities.
• Exceptional attention to detail.
• Effective written and verbal communication skills.
• Ability to manage multiple priorities and meet deadlines.
• Proficient in Microsoft Office, particularly Excel.
• Ability to work independently in a fast-paced environment.

Preferred Qualifications

• Certified Professional Coder (CPC), Certified Professional Biller (CPB), or Certified Revenue Cycle Representative (CRCR).
• Experience with behavioral health billing, telehealth claims, and provider credentialing.
• Familiarity with DrChrono or similar behavioral health EHR systems.

Job Type
Full-Time