Credentialing Specialist and Billing Specialist
5 days ago
Position Summary:
We are seeking an experienced credentialing and billing specialist with expertise in medical billing, insurance claims processing, rejections management, and provider credentialing. The ideal candidate must be detail-oriented, organized, and knowledgeable in navigating payer requirements to ensure timely and accurate reimbursements and credentialing for healthcare providers. Must have experience and must be available to start immediately.
Key Responsibilities:
- Submit accurate insurance claims (electronic and paper) to commercial, Medicaid, and Medicare payers.
- Review and resolve claim rejections, denials, and underpayments promptly.
- Perform insurance follow-ups to ensure timely reimbursement.
- Maintain up-to-date knowledge of payer guidelines and CPT/ICD-10 codes.
- Complete and manage provider credentialing and recredentialing applications for multiple payers, including locations address updates ect.
- Track application statuses and follow up with insurance companies to ensure timely approvals.
- Update and maintain accurate records of contracts, credentialing statuses, and CAQH profiles.
- Collaborate with providers, billing vendors, and internal staff to ensure credentialing and billing compliance.
- Assist with patient billing inquiries and verify insurance eligibility as needed.
Qualifications:
- Minimum 2 years of experience in medical billing and credentialing.
- Strong understanding of insurance claims, billing procedures, EOBs, and denial codes.
- Experience with payer portals, CAQH, Availity, PECOS, and other credentialing platforms.
- Excellent communication and follow-up skills.
- High attention to detail and strong organizational abilities.
Preferred Qualifications:
- Experience with Primary care and telehealth practices
- Working knowledge of insurance contracts and fee schedules
Job Type: Part-time
Pay: From Php185.00 per hour
Benefits:
- Flexible schedule
- Work from home
Experience:
- CAQH: 2 years (Required)
- PECOS: 2 years (Required)
- Availity: 2 years (Required)
Work Location: Remote
Expected Start Date: 11/24/2025
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