Billing Manager and Credentialing

Service Core Inc.•Youngstown, OH

About The Position

The Billing & Credentialing Manager is responsible for overseeing all billing operations and credentialing processes to ensure accurate, timely claim submission and full compliance with healthcare regulations. This role manages billing staff, monitors workflows, resolves claim issues, and collaborates with internal departments to optimize reimbursement and revenue cycle performance.

Requirements

Minimum of 3 years in medical billing (required)
Medicaid and commercial insurance billing (required)
CPT coding and claim accuracy
Electronic healthcare billing systems (e.g., Credible)
Strong attention to detail and organizational abilities
Advanced proficiency in Microsoft Excel and Office Suite
Excellent communication and problem-solving skills
Ability to manage multiple priorities and meet deadlines
Leadership and team management
Analytical thinking and process improvement
Regulatory compliance awareness
Revenue cycle optimization
Cross-functional collaboration

Nice To Haves

Behavioral health billing (preferred)

Responsibilities

Oversee all billing functions, including claim generation, submission, and follow-up.
Ensure accurate and timely claim batch creation for Medicaid, MCOs, and SmartCare.
Monitor deposits, including Medicaid/MCO payments and SmartCare transactions.
Research payment discrepancies; adjust client balances as needed.
Resolve zero-dollar payments from Medicaid and MCOs.
Investigate and correct failed or denied claims, including contacting payers.
Maintain and update the billing batch logs weekly.
Process and reconcile past deposits.
Complete billing for ACT team services.
Ensure consistent weekly claim creation to maintain steady cash flow.
Maintain a strong working knowledge of the Billing Matrix within Credible.
Analyze reimbursement trends and implement process improvements to maximize revenue.
Ensure compliance with all internal policies and external billing regulations.
Oversee credentialing for all providers across COMPASS locations.
Complete credentialing for new hires within 14 days of employment.
Prepare and process credentialing documents for licensed professionals.
Obtain NPIs for licensed staff and Medicaid numbers for non-licensed staff.
Conduct monthly Medicare provider eligibility verifications.
Maintain and update the master list of insurance contracts and electronic records.
Obtain required signatures on insurance contracts and amendments.
Maintain and update the insurance grid to ensure accurate provider eligibility by payer.
Prepare licensed staff for Behavioral Health redesign, including applications and W9 forms.
Collaborate with HR to initiate credentialing for new employees.
Update ACT spreadsheet monthly with payment activity.
Serve as liaison between billing and clinical departments.
Manage and supervise billing staff to ensure productivity and accuracy.
Identify and implement workflow improvements across billing and credentialing functions.
Perform additional duties as assigned by leadership.