Credentialing and Billing Specialist

Job Summary

A company is looking for a Credentialing and Billing Operations Specialist.

Key Responsibilities

• Manage the end-to-end credentialing process, including identifying health plans and submitting enrollment applications
• Oversee revenue cycle management processes, ensuring timely claims reimbursement and resolving billing discrepancies
• Maintain compliance with federal, state, and payer-specific requirements while tracking performance metrics

Required Qualifications

• Extensive experience in healthcare provider credentialing and enrollment
• Knowledge of payer enrollment processes, including CAQH, NPPES, and PECOS
• Experience in end-to-end revenue cycle management and process improvement
• Proficiency in Microsoft Office, particularly Excel, and relevant billing and credentialing software
• Ability to work independently in a startup environment with minimal structure