Credentialing and Billing Specialist

CFGC • Dallas, TX

3d • Onsite

About The Position

Child and Family Guidance is hiring a skilling Credentialing and Billing Specialist for the Dallas office. The Credentialing & Billing Specialist plays a vital role in supporting the financial operations and provider network integrity of our mental and behavioral health organization. This position manages provider credentialing/enrollment and billing functions to ensure seamless payer participation, accurate claims submission, and timely reimbursement. The ideal candidate is detail-oriented, experienced in healthcare revenue cycle processes, and comfortable working with clinical and administrative teams.

Requirements

• High school diploma or GED equivalent.
• Experience Managed Care Organization (MCO) and Medicaid.
• Experience in CPT, ICD-10 coding, and medical terminology.
• Minimum of two or more years of experience in healthcare billing & collection practices, working with Medicaid/Medicare and commercial insurance billing.
• Minimum of two or more years of healthcare credentialing for providers
• Understanding of Medicaid, Medicare, and commercial healthcare billing.
• Experience with credentialing systems (CAQH, PECOS, PEMS) and payer portals.
• Strong organization and follow-up skills.
• Knowledge of local, state, and federal laws related to healthcare billing.
• Ability to communicate and interact professionally with others.
• Ability to maintain spreadsheet sensitive data with credentialing and billing requirements.
• Ability to gather, assemble, and correlate information.
• Ability to solve problems under pressure and analyze data.
• Excellent verbal, written and organizational
• Ability to provide exceptional internal and external customer service.
• Self-motivated, detail-oriented individual with a collaborative team player
• Meticulous attention to detail.
• Knowledge of regulatory compliance and privacy standard.
• Ability to multitask and accept Billing Manager prioritization of job duties.
• Understanding of and commitment to appropriate protection of confidential patient information.
• Must be able to have a HIPAA secure environment when telecommuting.

Nice To Haves

• Prior experience in mental and/or behavioral health environment.
• Certification in medical billing or credentialing (e.g., CPB, CPC).
• Familiarity with telehealth billing and behavioral health modifiers.
• Experience with EHR and billing platforms.
• Skilled in operating various medical record software and hardware, word-processing, and database software programs; minimum of 50 WPM preferred.

Responsibilities

• Managing full provider credentialing and recredentialing for licensed behavioral health clinicians.
• Handling enrollments with commercial payers, Medicaid, Medicare, and managed care plans.
• Maintaining and updating provider information in CAQH, PECOS, and payer portals.
• Tracking expiration and renewal deadlines to avoid lapses in credentialing.
• Communicating with payers and internal stakeholders regarding credentialing status and requirements.
• Preparing and submitting claims for behavioral health services accurately and on time.
• Monitoring claim statuses, research denials, and follow up to secure payment.
• Completing daily pre-billing report and review errors & corrections.
• Review explanation of benefits and reconcile payment postings.
• Posting payments for non-835 claims to Netsmart.
• Verifying posting accuracy of self-pay and sliding scale guarantors.
• Identifying billing errors and work with clinical/documentation teams to resolve.
• Assisting with appeals and resubmissions as needed.
• Managing inbound and outbound client billing calls within same business day.
• Providing assistance with billing questions by responding to client calls and emails.
• Accepting or processing client payments.
• Ensuring compliance with payer rules, state, and federal billing regulations.
• Assisting with audit preparation and responding to payer requests.
• Tracking trends in credentialing and billing to support quality improvement initiatives.
• Generating reports on billing metrics, payer participation, and credentialing status.

Benefits

• Comprehensive benefits offered: Medical, Dental, Vision, Basic Life, Short term disability, Long term disability, Voluntary life, Accidental death & dismemberment, Voluntary Accident, Critical Illness, Legal & 401K
• Paid time off (vacation and sick time)

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 251-500 employees