Outpatient Credentialing Specialist/ AR Specialist

TMC•Homosassa, FL

About The Position

We are seeking a detail-oriented and experienced Outpatient Part B Credentialing Specialist / AR Specialist to support our revenue cycle operations. This role is responsible for managing provider credentialing and enrollment for Medicare Part B and commercial payers, while also overseeing accounts receivable follow-up to ensure timely reimbursement. The ideal candidate has strong knowledge of outpatient billing, Medicare regulations, and payer enrollment processes.

Requirements

Minimum 2–3 years of experience in Medicare Part B credentialing and/or outpatient AR
Strong knowledge of Medicare Part B billing guidelines and outpatient reimbursement
Experience with PECOS, CAQH, NPPES, and payer portals
Familiarity with EHR and practice management systems
Understanding of CPT, ICD-10, and HCPCS coding basics
Strong analytical, organizational, and problem-solving skills
Excellent written and verbal communication skills
Ability to manage multiple priorities and meet deadlines
Detail-oriented and compliance-focused
Strong follow-through and persistence with payers
Confidentiality and HIPAA compliance
Team-oriented with ability to work independently

Nice To Haves

Experience in outpatient therapy, physician practice, or rehab settings
Knowledge of Medicare LCD/NCD policies
CPC or CRCR certification (preferred but not required)

Responsibilities

Manage Medicare Part B provider enrollment, revalidations, and updates through PECOS and other payer portals
Submit and track provider credentialing applications with commercial and government payers
Maintain CAQH profiles and ensure accuracy of provider data
Monitor credentialing expirations and ensure timely renewals
Communicate with payers regarding application status, missing documentation, and follow-ups
Maintain provider credentialing files in compliance with regulatory standards
Perform timely follow-up on unpaid and underpaid outpatient claims
Review denials and rejections, identify root causes, and initiate corrective action
Submit appeals with appropriate documentation
Post payments and adjustments accurately when needed
Work closely with billing and coding teams to resolve claim issues
Maintain aging reports and meet established AR performance goals
Identify trends impacting reimbursement and report to leadership