Remote Medical Credentialing & Billing Specialist

Thrivelab Co.; États-Unis; À distance; USD 55 000 - 75 000; Plein temps

Résumé du poste

Thrivelab Co. is seeking a highly skilled Medical Insurance Credentialing Specialist to manage provider credentialing, enrollment, and billing across multiple payers in a remote setting. You will coordinate with providers, submit applications, and ensure timely reimbursements.

The role emphasizes accuracy, regulatory compliance, and effective communication with payers and clinical staff, with opportunities to implement process improvements and enhance credentialing workflows.

Qualifications

• High school diploma or equivalent required; associate or bachelor’s degree preferred.
• Certification in medical billing/coding (CPB, CPC, or equivalent) is a plus.
• Minimum 2 years of experience in medical credentialing and/or billing, preferably across multiple payers.
• Strong working knowledge of CAQH ProView, NPPES, PECOS, Availity, payer portals, and EHR/billing software.
• Proven track record of accurate claim submission, denial resolution, and maintaining compliance with payer requirements.

Responsabilités

• Prepare and submit credentialing applications for new providers to a variety of insurance payers.
• Complete re-credentialing processes according to payer timelines to avoid network participation lapses.
• Maintain accurate and up-to-date provider records in credentialing databases and payer portals.
• Coordinate with providers to obtain necessary documentation, certifications, licenses, and signatures.
• Accurately review, prepare, and submit medical insurance claims for a variety of payers using EHR/billing systems.
• Ensure proper coding using CPT, HCPCS, ICD-10, and modifier guidelines.
• Validate patient demographics, insurance eligibility, and coverage details before claim submission.
• Navigate multiple payer portals for claim status, adjustments, and appeals.
• Post payments, contractual adjustments, and write-offs accurately.
• Identify and address underpayments and payment discrepancies.
• Reconcile daily/weekly/monthly payment reports to ensure accuracy.
• Research and analyze claim denials and rejections.
• Prepare and submit timely appeals with appropriate documentation.
• Maintain follow-up logs to track outstanding claims until resolved.
• Adhere to HIPAA, CMS, and payer compliance guidelines.
• Maintain accurate and complete billing records in accordance with office policies.
• Stay updated on insurance and coding changes through continuing education.

Connaissances

Attention to detail

Organizational skills

Time management

Problem solving

Communication skills

Multitasking

Formation

High school diploma or equivalent

Associate or Bachelor’s degree in healthcare administration or related field

Medical billing/coding certification (CPB, CPC)

Outils

CAQH ProView

NPPES

PECOS

Availity

Payer portals

EHR/billing software

Description du poste

Thrivelab Co. is seeking a highly skilled Medical Insurance Credentialing Specialist to manage provider credentialing, enrollment, and billing across multiple payers in a remote setting. You will coordinate with providers, submit applications, and ensure timely reimbursements.

The role emphasizes accuracy, regulatory compliance, and effective communication with payers and clinical staff, with opportunities to implement process improvements and enhance credentialing workflows.