Medical Billing & Provider Credentialing Specialist

Job Summary

We are seeking an organized, detail-oriented Healthcare Billing & Provider Credentialing Specialist for a full-time, Monday–Friday administrative role. This position is the operational backbone of our practice, sitting at the intersection of revenue cycle management and provider onboarding. You will be responsible for ensuring seamless billing workflows, aggressively resolving insurance denials, and independently managing the credentialing process for incoming providers. While primarily administrative, this role requires exceptional professional communication skills for direct client billing interactions.

Requirements

Roles and Responsibilities

1. Provider Credentialing & Onboarding (High Priority)

• End-to-End Credentialing: Oversee and execute the complete primary source verification and credentialing process for all incoming clinical providers.
• Onboarding Management: Ensure a friction-free onboarding experience for new hires, tracking CAQH profiles, NPI updates, and commercial/government insurance panel applications.
• Compliance Maintenance: Monitor, maintain, and renew active provider credentials, licenses, and insurance panel memberships to prevent gaps in billing eligibility.

2. Revenue Cycle Management & Billing Administration

• Claims Processing: Audit and process clinical notes daily within SimplePractice to ensure accurate, timely claim submission.
• Denial & Claims Resolution: Proactively track, appeal, and resolve insurance denials. Directly contact insurance payers to troubleshoot payment delays and claim discrepancies.
• Ledger Management: Maintain clean billing records within the EMR, adjusting claims and managing patient balances with high precision.

3. Client Interaction & Account Communication

• Billing Support: Act as the primary point of contact for patient/client billing inquiries via phone and secure messaging.
• Financial Transparency: Clearly explain insurance benefits, deductibles, copays, and outstanding balances to clients with empathy and professionalism.
• Payment Coordination: Establish payment plans and follow up on overdue client accounts in accordance with practice policies.

4. Practice Operations & Systems Navigation

• SimplePractice Mastery: Maintain expert-level navigation of the SimplePractice EMR to manage administrative documentation, scheduling updates, and billing codes.
• Telephony Coordination: Utilize the Weave phone system to efficiently manage inbound/outbound calls, patient text routing, and team communications.
• Daily Schedule Adherence: Maintain reliable, independent output across a standard Monday through Friday operational schedule.