Credentialing & Billing Coordinator

Physical Therapy & Sports Medicine Centers • West Hartford, CT

6h • Remote

About The Position

PTSMC is hiring a Credentialing & Billing Coordinator. As a member of the Billing team, this role plays a vital part in supporting our revenue cycle by leading insurance credentialing for PTSMC providers and locations, maintaining accurate insurance information, and helping ensure claims are processed efficiently. The ideal candidate is detail-oriented, enjoys problem-solving, and thrives in a collaborative environment where their work directly supports quality patient care and operational success.

Requirements

• Detail-oriented
• Enjoys problem-solving
• Thrives in a collaborative environment

Responsibilities

• Credential all individual clinicians and provide timely updates throughout the process
• Manage EMR signature rules to facilitate accurate and clean claims submission
• Provide insurance carriers with information needed to re-credential current clinicians and locations
• Maintain CAQH records for current PTSMC clinicians
• Complete the application and learn the credentialing process for participation with new networks
• Initiate temporary permit process & follow up with partner and new hire on status when applicable
• Keep track of license transfers, when applicable, and follow up with partner and new hire on status as needed
• Complete quarterly provider and demographic verifications for all participating insurances
• Resolve issues related to missing or incorrect provider demographic information with payers
• Filter and submit claims from In-Review work queue daily to insurance carriers
• Take appropriate action to correct failed edits, claim rejections, and insurance changes
• Resubmit modified or corrected charges once claim addendum is complete
• Manage self-pay visits by reviewing patient charges and creating remit to close out visits
• Maintain a working knowledge of ICD-10 diagnosis codes, CPT billing codes, modifiers, and non-reimbursable codes
• Remain current with PTSMC insurance participation, contract reimbursement, payer guidelines, and policies
• Update insurance information and rebill claims when required to resolve billing issues
• Monitor billing that is on hold for new non-credentialed providers
• Review and resolve claims denials related to provider participation
• Keep informed of insurance policy changes through website updates and insurance newsletters
• Assist in coordination and communication of insurance information to facilitate accurate billing

Benefits

• 401(k)
• Dental insurance
• Disability insurance
• Health insurance
• Life insurance
• Paid time off

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed