Credentialing & Billing Coordinator

Physical Therapy & Sports Medicine Centers; Oregon; Hybrid; USD 52,000 - 76,000; Full time

Benefits offered by this job

401(k)

Dental insurance

Disability insurance

Health insurance

Life insurance

Paid time off

Job summary

Physical Therapy & Sports Medicine Centers is hiring a Credentialing & Billing Coordinator for a remote role in the United States. You will lead insurance credentialing for providers and locations, maintain accurate insurance information, and support efficient claims processing to enhance revenue cycle performance.

The ideal candidate is detail-oriented, enjoys problem-solving, and thrives in a collaborative environment that supports quality patient care and operational success.

Qualifications

• Experience with credentialing and licensure processes.
• Knowledge of ICD-10, CPT codes and modifiers.
• Familiarity with payer policies and insurance networks.

Responsibilities

• Credential clinicians and manage licensure updates.
• Handle EMR signature rules to ensure clean claims.
• Maintain CAQH records for clinicians.
• Process credentialing for new networks.
• Submit and resubmit claims; resolve denials.
• Monitor billing on hold for non-credentialed providers.
• Keep up with insurer participation and policies.

Skills

Detail oriented

Problem solving

Collaboration

Time management

Tools

EMR software

Billing software

CAQH system

Job description

PTSMC is hiring a Credentialing & Billing Coordinator. As a member of the Billing team, this role plays a vital part in supporting our revenue cycle by leading insurance credentialing for PTSMC providers and locations, maintaining accurate insurance information, and helping ensure claims are processed efficiently. The ideal candidate is detail-oriented, enjoys problem-solving, and thrives in a collaborative environment where their work directly supports quality patient care and operational success.

Responsibilities for this remote position include: Credentialing & Licensure

• Credential all individual clinicians and provide timely updates throughout the process
• Manage EMR signature rules to facilitate accurate and clean claims submission
• Provide insurance carriers with information needed to re-credential current clinicians and locations
• Maintain CAQH records for current PTSMC clinicians
• Complete the application and learn the credentialing process for participation with new networks
• Initiate temporary permit process & follow up with partner and new hire on status when applicable
• Keep track of license transfers, when applicable, and follow up with partner and new hire on status as needed
• Complete quarterly provider and demographic verifications for all participating insurances
• Resolve issues related to missing or incorrect provider demographic information with payers

Billing & Claims Resolution

• Filter and submit claims from In-Review work queue daily to insurance carriers
• Take appropriate action to correct failed edits, claim rejections, and insurance changes
• Resubmit modified or corrected charges once claim addendum is complete
• Manage self-pay visits by reviewing patient charges and creating remit to close out visits
• Maintain a working knowledge of ICD-10 diagnosis codes, CPT billing codes, modifiers, and non-reimbursable codes
• Remain current with PTSMC insurance participation, contract reimbursement, payer guidelines, and policies
• Update insurance information and rebill claims when required to resolve billing issues

Revenue Cycle Support

• Monitor billing that is on hold for new non-credentialed providers
• Review and resolve claims denials related to provider participation
• Keep informed of insurance policy changes through website updates and insurance newsletters
• Assist in coordination and communication of insurance information to facilitate accurate billing

Benefits

• 401(k)
• Dental insurance
• Disability insurance
• Health insurance
• Life insurance
• Paid time off

ABOUT THE ORGANIZATION

Our MissionImproving the quality of people's lives by providing:

• Unmatched experiences
• Clinical excellence
• Lifelong relationships

Who We ArePhysical Therapy & Sports Medicine Centers is Connecticut's largest private-practice physical therapy company with 37 locations around the state serving more than 20,000 patients every year.

Our ReputationPhysical Therapy & Sports Medicine Centers has achieved a reputation as a leader in healthcare throughout the state of Connecticut, improving the quality of life for our patients with a 'patient-centric' approach to physical therapy. Our aim is to return individuals to work, athletics, activity level and the lifestyle they enjoyed prior to pain, injury or surgery.

PT for Life Culture

At PTSMC, we are always building our 'PT for Life' culture. 'PT for Life' is our philosophy for how we treat each other and our customers, be they patients, friends, family or clients. It is our commitment to provide excellent care and service to all who interact with PTSMC - from the first touchpoint to the moment a patient leaves feeling better - and to build lifelong relationships along the way.

We are proud to be named a 'Top Workplace' in Connecticut for 14 consecutive years and a Top Workplace USA for 5 years.Learn more about PTSMC by visiting and find us on Facebook, Instagram and LinkedIn!