The Billing and Credentialing Specialist is responsible for medical billing processes and overseeing provider credentialing activities. This role ensures accurate and timely claim submission, reimbursement, and compliance with payer requirements while maintaining provider credentials with insurance networks and regulatory bodies. This role is onsite in Jamaica, NY.

Billing Duties

• Prepare, review, and submit medical claims to insurance carriers in an accurate and timely manner
• Verify patient insurance coverage and benefits prior to billing
• Monitor claim status and follow up on unpaid or denied claims
• Resolve billing discrepancies and work with payers to ensure proper reimbursement
• Post payments, adjustments, and denials into the billing system
• Maintain compliance with payer guidelines and healthcare regulations (HIPAA, etc.)
• Communicate with patients regarding billing inquiries and payment options

Credentialing Duties

• Manage the credentialing and re-credentialing process for healthcare providers
• Prepare and submit credentialing applications to insurance companies and regulatory agencies
• Track application status and follow up to ensure timely approval
• Maintain up-to-date provider records, licenses, certifications, and continuing education
• Ensure providers are enrolled and active with appropriate payer networks
• Monitor expiration dates and renew credentials as needed
• Maintain compliance with organizational policies and industry standards

Qualifications

• High school diploma or equivalent required; associate or bachelor’s degree preferred
• 3+ years of experience in medical billing or credentialing, or a related healthcare role
• Knowledge of CPT, ICD-10, and HCPCS coding preferred
• Familiarity with insurance verification, claims processing, and denial management
• Experience with credentialing software and electronic medical record (EMR) systems
• Strong attention to detail and organizational skills
• Excellent communication and problem-solving abilities