Billing Credentialing Specialist: Denial & Reimbursement

Wolcott, Wood and Taylor Inc.; Chicago (IL); On-site; USD 60,000 - 85,000; Full time

Job summary

Wolcott, Wood and Taylor Inc. seeks a Billing Credentialing Specialist to review, analyze, and resolve professional billing claim edits and denials related to provider credentialing.

You will research issues, identify root causes, and coordinate provider updates to maximize reimbursement. The role collaborates with Billing, Managed Care, Credentialing, and other departments to ensure provider information is accurate across payer systems and internal databases.

Qualifications

• Minimum three years of experience in revenue cycle processes and denial management.
• Experience with provider credentialing and payer requirements preferred.
• Proficient with EPIC and Microsoft Office applications.

Responsibilities

• Review, analyze, and resolve professional billing claim edits and denials, identifying root causes and corrective actions.
• Collaborate with Managed Care, Credentialing, Billing, and other departments to resolve billing, enrollment, credentialing, and demographic issues.
• Research payer requirements and maintain accurate provider information in NPPES and internal systems.
• Monitor credentialing status and release of held charges in Epic.
• Manage AR and denial queues, prioritizing high-dollar and aging claims for timely follow-up.
• Resubmit denied or corrected claims after updates.
• Monitor denial trends and communicate findings to departments and management.
• Generate reports on claim edits, denials, credentialing issues, and performance metrics.
• Communicate credentialing and billing issues to appropriate departments and management.
• Perform additional duties as assigned.

Skills

Denials management

Credentialing knowledge

Analytical thinking

Attention to detail

Written and verbal communication

Microsoft Office

Organizational skills

Problem solving

Customer relationships

Confidentiality

Team collaboration

Tools

EPIC software

Excel

Word

Outlook

Job description

Wolcott, Wood and Taylor Inc. seeks a Billing Credentialing Specialist to review, analyze, and resolve professional billing claim edits and denials related to provider credentialing.

You will research issues, identify root causes, and coordinate provider updates to maximize reimbursement. The role collaborates with Billing, Managed Care, Credentialing, and other departments to ensure provider information is accurate across payer systems and internal databases.