Credentialing & Billing Specialist

Goodwill Easterseals Miami Valley•Dayton, OH

7d•Onsite

About The Position

The Credentialing & Billing Specialist is responsible for ensuring accurate and timely provider credentialing, payer enrollment, and revenue cycle support. This role serves as a critical bridge between front-end operations and billing, helping prevent denials, improve compliance, and optimize reimbursement outcomes.

Requirements

Associate degree required; bachelor’s degree in healthcare administration, business or related field preferred. At least 5 years of related experience may be considered in lieu of degree.
Minimum of 3-5 years of experience in medical billing, credentialing, payer enrollment, or revenue cycle operations.
Demonstrated hands-on experience with provider credentialing and payer enrollment processes.
Experience working with Medicare, Medicaid, and commercial payers.
Familiarity with eligibility verification and front-end revenue cycle workflows.
Experience identifying and resolving claim denials or reimbursement issues.
Ability to pass a criminal background check.
Must maintain a valid driver’s license in preparation for any driving for the agency.
Strong knowledge of credentialing, payer enrollment, and revenue-cycle processes
Understanding of how front-end processes impact billing outcomes and denial rates
Experience with credentialing systems (e.g. PECOS) and billing/EMR platforms
Excellent organizational skills with the ability to track multiple providers, deadlines, and requirements
Strong analytical and problem-solving skills with a focus on root cause analysis
Ability to design and improve workflow processes
High attention to detail and commitment to data accuracy
Effective communication skills with the ability to work cross-functionally (billing, intake, clinical, and leadership teams)
Strong understanding of HIPAA and payer compliance requirements

Responsibilities

Advise on end-to-end provider credentialing and payer enrollment processes, including initial applications, re-credentialing and ongoing maintenance
Maintain and update provider information in PNM System, CAQH, PECOS and payer-specific portals
Track credentialing and enrollment status, ensuring timely completion and preventing lapses in participation
Serve as the primary point of contact with payers for enrollment status, issue resolution, and follow-up
Maintain accurate records of provider credentials, licenses, certifications, and payer participation status.
Design, implement and continuously improve credentialing and enrollment workflows to increase efficiency and reduce delays
Establish tracking systems and controls for re-credentialing cycles, expirations, and compliance requirements
Identify root causes of enrollment or credentialing delays and implement process improvements
Collaborate with leadership to standardize and document processes across revenue cycle functions
Advise and support front desk and intake staff on best practices for eligibility verification, insurance capture, and authorization processes
Assist in developing and improving front-end workflows to ensure accurate patient and payer information before services are rendered
Identify trends in eligibility or intake errors that contribute to claim denials and recommend corrective actions
Support training and guidance for staff related to front-end revenue cycle processes
Assist with medical billing functions including claim submission, follow-up, and resolution of denials
Analyze denial patterns and partner with front-end and credentialling functions to address root causes
Work collaboratively with billing staff to ensure clean claim submission and timely reimbursement
Support continuous improvement in clean claims rates, A/R performance, and denial reduction
Ensure compliance with HIPAA, CARF, payer requirements, and regulatory guidelines related to credentialing and billing
Maintain confidentiality and security of protected health information (PHI)
Support audit preparation and documentation of credentialing, enrollment, and revenue cycle processes
Promote data accuracy and consistency across systems used for credentialing, billing, and provider management
Other duties as assigned