Billing and Credentialing Specialist
About The Position
Are you a detail-oriented problem solver who thrives in the world of behavioral health billing and credentialing? Do you get a strange thrill from reconciling reports, clearing denials, and navigating Medicaid regulations like a pro? If so, we want you on our team! As our Billing & Credentialing Specialist, you’ll be the behind-the-scenes hero ensuring accurate, timely billing and making sure our licensed providers are fully credentialed and compliant. You’ll work with multiple systems, communicate with state agencies, and support our programs by being the go-to expert on everything from Medicaid to PNM provider enrollments.
Requirements
- High School Diploma or equivalent.
- 3+ years’ experience with federal and state billing practices.
- Knowledge of billing systems and insurance regulations.
- Strong organizational and communication skills.
- Experience with credentialing protocols and systems.
Nice To Haves
- Ethical conduct and confidentiality
- Time and project management prowess
- Financial savvy
- Outstanding communication and customer service skills
- Tech-savvy (MS Office Suite, including Excel and Teams)
- Calm under billing-related pressure
Responsibilities
- Maintain system user setups for seamless billing operations.
- Upload essential billing files for Medicaid billing accuracy.
- Tackle complex billing and payment issues—no mystery is too deep.
- Scrub away denials and rejections, partnering with program staff to resolve errors.
- Provide essential billing reports and reconciliations.
- Serve as the subject matter expert on Medicaid billing configurations and best practices.
- Attend monthly meetings with MCO’s and collaborative agencies.
- Collaborate with IT, Accounting, and Program teams to ensure efficient workflows.
- Stay on top of policy changes from the Ohio Department of Medicaid and other authorities.
- Own the credentialing process—new hires, updates, renewals, CAQH enrollment and re-attestations.
- Troubleshoot discrepancies or credentialing gaps that could impact billing.
- Keep credentialing data clean and up-to-date in HR and EHR systems.
- Be the expert on NPI number systems and external credentialing protocols.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
