Credentialing and Billing Specialist

CFGC•Dallas, TX

1d•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

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.
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.

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.