Impactful Billing & Credentialing 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

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.