Medical Credentialing/Medical Billing Specialist

Clinical Professional Connections; Clearwater (FL); On-site; USD 60,000 - 70,000; Full time

Job summary

A growing healthcare team is seeking a Credentialing & Billing Specialist to manage credentialing processes, ensuring compliance with payor requirements. The role requires extensive experience with CAQH and a proactive approach to credentialing. The ideal candidate will collaborate with billing teams and maintain accurate provider information.

Benefits

Paid Time Off

Sick Leave Policy

Holidays

Medical Insurance

Dental Insurance

Vision Insurance

Qualifications

• Minimum of 5 years of healthcare credentialing experience.
• Must have Medical Billing background.

Responsibilities

• Manage end-to-end credentialing and recredentialing processes.
• Maintain provider information in credentialing databases.

Skills

Organizational Skills

Communication Skills

Attention to Detail

Education

CPCS Certification

Tools

Credentialing Software

Job description

Job Title: Credentialing /Billing Specialist
Location:Must be living in the United States
Employment Type: Full-Time

Overview:
We are seeking a highly organized and detail-oriented Credentialing & Billing Specialist to join our growing healthcare team. This full-time, role is pivotal in ensuring that our providers are properly credentialed and recredentialed with various payors. The ideal candidate will have extensive experience with CAQH and other credentialing platforms, a deep understanding of payor requirements, and a proactive approach to managing credentialing processes.
This position will also collaborate with our billing team and may assist with related administrative tasks as needed.
Key Responsibilities:

• Manage end-to-end credentialing and recredentialing processes for providers across multiple payors, ensuring compliance with all regulatory and contractual requirements.
• Maintain and update provider information in credentialing databases such as CAQH, PECOS, NPPES, and other payor-specific platforms.
• Conduct primary source verification of provider credentials, including education, training, licensure, certifications, and work history.
• Monitor and track the status of credentialing applications, following up with payors and providers to ensure timely completion.
• Develop and maintain a centralized credentialing management system to organize and track all provider documentation and credentialing activities.
• Collaborate with the billing department to ensure that credentialing status aligns with billing requirements and timelines.
• Stay informed about changes in credentialing standards, regulations, and payor requirements to ensure ongoing compliance.
• Assist in the development and implementation of credentialing policies and procedures.
• Provide training and support to providers and internal staff regarding credentialing processes and expectations.
• Participate in audits and provide documentation as needed to demonstrate compliance.

Additional Responsibilities:

• Provide weekly summary updates to internal leadership and client(s), detailing credentialing status, outstanding items, and progress.
• Communicate clearly and consistently with providers to collect any missing documentation.
• Ensure timely recovery of all required items to prevent delays in credentialing or recredentialing.
• Collaborate with external partners (e.g., MSOs or IPA administrators) as needed to support provider enrollment.

Qualifications:

• Minimum of 5 years of healthcare credentialing experience, including both initial credentialing and recredentialing.
• Must also have Medical Billing background (Primary Care Billing)
• In-depth knowledge of CAQH, PECOS, NPPES, and commercial payor platforms.
• Strong understanding of credentialing requirements across Medicare, Medicaid, and commercial payors.
• Experience with credentialing software..
• Exceptional organizational skills and attention to detail, with the ability to manage multiple tasks and strict deadlines.
• Strong communication skills (written and verbal) with a proactive, solutions-oriented mindset.
• Ability to work independently in a remote environment while collaborating effectively with a team.
• CPCS (Certified Provider Credentialing Specialist) preferred but not required.

Compensation/Benefits:

• Salary: $60-70,000 annually based on 5 years of experience
• Paid Time Off: 15 days accrued per calendar year. Absent state sick time laws, no paid or unpaid PTO will be approved prior to 90 days of employment.
• Sick Leave Policy, all full-time employees begin accruing sick leave immediately and my use it as it is accrued. Employees can accrue a maximum of 48 hours per year. Unused hours can roll from year to year, capped at a maximum of 80 hours. Once this cap is reached, no additional hours will be accrued until the total falls below the threshold.
• Holidays: 7 days: New Year’s Day, Memorial Day, July 4th, Labor Day, Thanksgiving Day, Day after Thanksgiving and Christmas Day*
• Benefits: Meta Care will pay 90% of “single” medical premium should you choose to opt in.
• Dental and Vision Insurance is available. You would be responsible for paying 100% of the premium for that coverage.
• We provide equal consideration to all qualified applicants, regardless of race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

To apply, please submit directly your resume and a cover letter highlighting your relevant experience to: [e-mail]