Billing & Credentialing Specialist — Healthcare Revenue

Tides Family Services, Inc.; Pawtucket (RI); On-site; USD 34,000 - 41,000; Full time

Job summary

Tides Family Services is a Rhode Island nonprofit seeking a detail-oriented Billing & Credentialing Specialist to support the revenue cycle through accurate claims submission, insurance follow-up, denials management, and provider credentialing. The ideal candidate has 2+ years in medical billing, experience with credentialing and payer enrollment, and knowledge of CPT/ICD-10/HCPCS coding.

Strong organizational skills and confidentiality are essential for success in this role.

Qualifications

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

Responsibilities

• 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

Skills

Medical billing

Credentialing

Payer enrollment

CPT/ICD-10/HCPCS coding

Communication

Microsoft Office

Echo Vantage

CPC certification

Tools

Echo Vantage

Job description

Tides Family Services is a Rhode Island nonprofit seeking a detail-oriented Billing & Credentialing Specialist to support the revenue cycle through accurate claims submission, insurance follow-up, denials management, and provider credentialing. The ideal candidate has 2+ years in medical billing, experience with credentialing and payer enrollment, and knowledge of CPT/ICD-10/HCPCS coding.

Strong organizational skills and confidentiality are essential for success in this role.