The Billing & Credentialing Specialist is responsible for managing the organization's billing and revenue cycle processes to ensure timely and accurate reimbursement for services. This position submits claims through the electronic medical record (EMR), monitors claim status, posts and reconciles payments, investigates and resolves denied or unpaid claims, and follows up with insurance companies to maximize reimbursement. The specialist also maintains accurate billing records, verifies authorizations and payer requirements, and works collaboratively with clinical and administrative staff to resolve billing discrepancies.

In addition to billing responsibilities, this position coordinates provider credentialing and recredentialing with Medicaid, Medicare, commercial insurance plans, and other payers. Responsibilities include completing provider enrollment applications, maintaining CAQH profiles, tracking credentialing status, monitoring renewal deadlines, and ensuring providers remain credentialed and eligible for reimbursement. The Billing & Credentialing Specialist plays a key role in maintaining compliance, optimizing revenue, and supporting the financial health of the organization.

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