Billing and Credential Specialist

TIDES FAMILY SERVICES INC; Pawtucket (RI); On-site; USD 34,000 - 41,000; Full time

Job summary

Tides Family Services is seeking a Billing & Credentialing Specialist to support the organization’s revenue cycle, including claims submission, follow-up, denial resolution, and provider credentialing.

The ideal candidate will have medical billing experience, knowledge of CPT/ICD-10/HCPCS coding, and familiarity with payer processes in a healthcare or behavioral health setting, contributing to accurate reimbursement and compliant operations.

Qualifications

• 2+ years of medical billing experience required.
• Experience with provider credentialing and payer enrollment required.
• Knowledge of CPT, ICD-10, and HCPCS coding.
• Familiarity with commercial insurance and Medicaid processes.

Responsibilities

• Review and prepare claims for submission within timely filing limits.
• Monitor claim status, resolve denials, rejections and underpayments.
• Post payments and reconcile accounts.
• Conduct insurance follow-up and appeals as needed.
• Verify patient benefits and eligibility.
• Manage patient billing inquiries and payment plans.
• Ensure compliance with payer policies and regulations.
• Track revenue cycle metrics and report findings.
• Maintain provider credentials and rosters with the team.
• Complete initial and re-credentialing applications for payers.
• Maintain CAQH profiles and current provider data.
• Track credentialing timelines and follow up with payers.

Skills

Medical billing

Credentialing

CPT ICD-10 HCPCS knowledge

Communication skills

Tools

Echo Vantage

Microsoft Office

Job description

Description

Tides Family Services is a nonprofit organization that is committed to providing comprehensive support and resources to children, adolescents, and families facing various challenges. The overall mission of Tides is to provide services and supports that allow youth to live in a community-based setting. An "Agency Without Walls" our services are delivered in homes, communities, schools...wherever our youth are.

Position Overview:

Tides Family Services is seeking a highly detail-oriented and proactive Billing & Credentialing Specialist to support the financial health and continued growth of our organization. This role is responsible for managing key components of the revenue cycle, including accurate claims submission, insurance follow-up, denial resolution, and provider credentialing.

The Billing & Credentialing Specialist plays a critical role in ensuring timely reimbursement, maintaining payer compliance, and supporting sustainable operations. This position requires strong organizational skills, attention to detail, and the ability to work independently while managing multiple deadlines and payer requirements.

The ideal candidate has experience in medical billing, insurance follow-up, and provider credentialing within a healthcare or behavioral health setting. They are solution-oriented, comfortable navigating payer systems, and committed to maintaining high standards of accuracy, accountability, and confidentiality.

This is an opportunity to contribute meaningfully to a growing organization by strengthening revenue integrity and operational systems that directly support our clinical team and the families we serve.

Essential Functions:

• Review and prepare claims for submission in accordance with timely filing limits
• Monitor claim status and resolve denials, rejections, and underpayments
• Post payments and reconcile accounts
• Conduct insurance follow-up and appeals as needed
• Verify patient benefits and eligibility
• Manage patient billing inquiries and payment plans
• Ensure compliance with payer policies and regulations
• Track and report key revenue cycle metrics
• Work within a multidisciplinary team to ensure current credentials and rosters are maintained.
• Complete initial and re-credentialing applications for commercial and government payers
• Maintain CAQH profiles and ensure provider data is current
• Track credentialing timelines and follow up with payers
• Maintain accurate provider documentation and credentialing files
• Assist with contracting and payer communications as needed

Requirements

• 2+ years of medical billing experience required
• Experience with provider credentialing and payer enrollment required
• Knowledge of CPT, ICD-10, and HCPCS coding
• Familiarity with commercial insurance and Medicaid processes

Knowledge, Skills, and Abilities:

• Strong organizational and time management skills with attention to detail.
• Proficiency in Microsoft Office Suite (Word, Excel, Outlook) and comfort with data entry systems.
• Excellent written and verbal communication skills.
• Ability to multitask and work both independently and as part of a team.
• Experience with Echo Vantage preferred
• CPC certification (or similar) is a plus

Salary Range:

$25.00-$30.00 per hour

Compensation will be determined based on the candidate’s experience, education, language capacity, skills, and other qualifications relevant to the role, in alignment with organizational parity guidelines and market conditions. The requirements listed above are representative of the knowledge, skills, and/or abilities required to satisfactorily perform essential duties. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Tides Family Services is an Equal Opportunity Employer that values our diverse workforce and encourages all mission-driven candidates to apply. We are a Recovery Friendly Employer, a BCBS Safe Zone Certified worksite, a Veteran Friendly workplace, and have been a multiple-year recipient of RI Monthly’s Best Places to Work. Join our team!