Credentialing & Billing Coordinator

PTSMC; West Hartford (CT); Remote; USD 50,000 - 70,000; Full time

Benefits offered by this job

401(k)

Disability insurance

Health insurance

Life insurance

Paid time off

Job summary

PTSMC is hiring a Credentialing & Billing Coordinator to join our remote Billing team, leading insurance credentialing for 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.

Qualifications

• Experience with credentialing and billing in healthcare.
• Knowledge of ICD-10 and CPT codes.
• Strong attention to detail and accuracy.
• Experience with EMR systems and CAQH records.

Responsibilities

• Credential all clinicians and update licensure status as needed.
• Manage EMR signature rules to ensure accurate claims submission.
• Provide information to carriers for re-credentialing.
• Maintain CAQH records for clinicians.
• Complete credentialing for new networks and providers.
• Track license transfers and follow up with partners/new hires as needed.
• Conduct quarterly provider and demographic verifications for participating insurances.
• Resolve issues related to missing/incorrect provider demographic information.

Skills

Detail-oriented

Problem-solving

Collaborative

Revenue cycle knowledge

ICD-10/CPT knowledge

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

ABOUT THE ORGANIZATION

Our Mission

Improving the quality of people's lives by providing:

• Unmatched experiences
• Clinical excellence
• Lifelong relationships

Who We Are

Physical 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.

Physical 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 www.ptsmc.com and find us on Facebook, Instagram and LinkedIn!