Medical Billing and Credentialing Specialist

Join a Growing Healthcare Organization

Are you an experienced medical biller who knows how to turn unpaid and denied claims into properly resolved accounts?

Do you understand Medicare and Medicare Advantage billing, eligibility, denials, appeals, payer follow-up, and provider enrollment?

Avocare Health Services is seeking a dependable and highly skilled Medical Billing and Credentialing Specialist to join our growing team. This is an excellent opportunity for someone who wants more responsibility, a positive work environment, and meaningful opportunities for advancement.

Avocare is a technology-enabled, value-based care organization that works with physicians and other healthcare organizations to improve care for Medicare patients. Our team supports care management, remote monitoring, behavioral health, telehealth, as well as, ACO and ACCESS operations designed to help patients remain healthier and more independent.

What You Will Do

In this position, you will:

• Submit and follow professional claims for Medicare, Medicare Advantage plans, Medicaid, and commercial health plans.
• Verify patient eligibility, plan enrollment, coverage dates, and coordination of benefits.
• Review claim rejections, denials, nonpayments, and underpayments.
• Correct and resubmit claims when appropriate.
• Prepare reconsiderations and appeals with complete supporting documentation.
• Follow unpaid claims through final payment or appropriate resolution.
• Review accounts receivable aging and prioritize claims requiring immediate action.
• Interpret explanations of benefits, electronic remittance advices, denial codes, and payer correspondence.
• Maintain clear and complete account notes.
• Identify recurring denial trends and recommend corrective action.
• Assist with provider credentialing and payer enrollment.
• Maintain CAQH provider profiles and assist with PECOS and NPPES updates.
• Track payer applications, revalidations, recredentialing deadlines, and effective dates.
• Assist with EFT and ERA enrollment.
• Communicate professionally with health plans, providers, patients, and Avocare staff.

What We Are Looking For

The ideal candidate will have:

• At least two to three years of medical billing or healthcare revenue cycle experience.
• Direct experience billing Medicare and Medicare Advantage plans.
• Experience verifying eligibility and resolving insurance coverage problems.
• Strong experience working denied, rejected, delayed, and unpaid claims.
• Experience preparing claim appeals or reconsiderations.
• Working knowledge of CPT, HCPCS, ICD-10-CM, modifiers, CMS-1500 claims, EOBs, and ERAs.
• Experience using payer portals and electronic billing systems.
• Strong attention to detail and excellent follow-through.
• The ability to work independently and manage multiple deadlines.
• Professional written and verbal communication skills.
• A positive attitude and willingness to contribute to a growing organization.

Preferred Experience

We are especially interested in candidates with experience in:

• Medicare PECOS
• CAQH
• NPPES
• Availity and other payer portals
• Provider enrollment and payer credentialing
• EFT and ERA enrollment
• Accounts receivable aging
• Denial tracking and root-cause analysis
• Care management or remote monitoring billing
• Physician practice or multispecialty billing

Professional billing or coding certification is preferred but not required for candidates with strong, relevant experience.

Why Join Avocare?

Avocare offers more than a billing position. We provide an opportunity to become an important member of a growing healthcare organization.

Full-time employees receive:

• Competitive pay of $25.50–$29.50 per hour
• Health insurance
• Paid sick days
• Paid time off
• Weekday work schedule
• An outstanding and professional office environment
• A supportive, respectful, and team-oriented workplace culture
• Training and professional development
• Excellent potential for increased responsibility and career growth

The successful candidate will have the opportunity to help strengthen Avocare’s billing and credentialing operations as the organization expands.

Apply Today

Please submit your résumé and a brief statement describing your experience with:

• Medicare and Medicare Advantage billing
• Denials, nonpayment follow-up, and appeals
• Eligibility verification
• Provider credentialing or payer enrollment

Candidates selected for an interview may be asked to discuss examples of denied claims they successfully resolved and their experience working with payer portals and credentialing systems.

Avocare Health Services is an equal opportunity employer.

Pay: $24.50 - $29.50 per hour

Benefits:

• Dental insurance
• Health insurance
• Vision insurance

Application Question(s):

• What is your understanding of Front-End and Back-End Billing?

Experience:

• Medical billing: 2 years (Required)
• Credentialing: 2 years (Preferred)

License/Certification:

• Medical Billing Certification (Required)

Work Location: In person

Salary : $25 - $30