Medical Billing Coordinator / Credentialing Specialist

Job Overview
Community Medicine Inc. is a Federally Qualified Health Center (FQHC) committed to providing comprehensive, high-quality, and affordable healthcare to underserved communities. We are seeking a skilled and detail-oriented Medical Biller / Credentialing Specialist to join our team and support the financial and operational health of our organization.

This dual-role position is responsible for managing all aspects of medical billing and revenue cycle operations, as well as provider credentialing and contracting with IPAs and health plans. The ideal candidate is highly organized, experienced with FQHC billing requirements, and able to ensure the timely and accurate credentialing of new providers.

Duties : Medical Billing & Revenue Cycle

• Prepare and submit claims to Medi-Cal, Medicare, and commercial insurance carriers accurately and timely.
• Run and verify patient eligibilities across all payers.
• Code claims accurately using ICD-10 and CPT codes.
• Monitor and resolve claim denials and rejections; follow up on unpaid claims.
• Maintain records and reports to track billing performance, payments, deductibles, and outstanding balances.
• Utilize EMR (Electronic Medical Records) and EHR (Electronic Health Records) systems to input and retrieve patient information.
• Collaborate with healthcare providers to resolve billing discrepancies and clarify any issues related to patient accounts.
• Ensure compliance with federal, state, and payer-specific regulations.
• Generate and analyze billing reports to identify trends and areas for improvement.
• Stay updated on changes in medical billing regulations, coding guidelines, and insurance policies.

Credentialing & Contracting

• Complete and submit provider credentialing applications, including CPPA forms, for new and existing providers.
• Maintain and update provider files to ensure compliance with payer requirements and accreditation standards.
• Coordinate and negotiate contracts with IPAs, HMOs, and health plans.
• Track credentialing status and re-credentialing timelines to avoid disruptions in billing or provider participation.
• Serve as the primary contact for health plans, IPAs, and credentialing bodies.
• Should have knowledge and understanding of PAVE, PECOS and CAQH.

Experience

• Proven experience in medical billing, coding, or related roles within a medical office setting is preferred.
• Familiarity with medical terminology and understanding of various coding systems, including ICD coding, is essential.
• Experience with EMR and EHR systems is highly desirable.
• Strong attention to detail, organizational skills, and the ability to work independently are crucial for success in this role.
• Previous experience in medical collections will be considered an asset. If you are passionate about healthcare administration and possess the necessary skills in medical billing and coding, we encourage you to apply for this exciting opportunity to contribute to our team.

Qualifications

• Education: High school diploma or equivalent required; Associate’s degree or certification in Medical Billing/Coding preferred.
• Experience: Minimum 3 years’ experience in medical billing for an FQHC or similar healthcare setting.
• Strong knowledge of Medi-Cal and Medicare billing guidelines.
• Experience running patient eligibility.
• Proficient in ICD-10 and CPT coding.
• Knowledge of deductibles and patient responsibility.
• Experience completing CPPA forms and handling provider credentialing.
• Familiarity with contracting processes for IPAs and health plans.
• Proven ability to work on denials and manage the full billing cycle.
• Proficiency with EHR/EMR systems and Microsoft Office Suite (Excel, Word, Outlook).
• Excellent organizational skills and attention to detail.
• Strong communication and negotiation skills.

Benefits

• Health insurance.
• Like Insurance
• 401K Matching
• Paid time off and holidays.
• Paid Sick leave
• Professional development opportunities.

Job Types: Full-time, Part-time

Pay: $22.00 - $28.00 per hour

Expected hours: 32 per week

Benefits:

• 401(k) matching
• Health insurance
• Life insurance
• Paid time off

Application Question(s):

• Are you familiar with the terms: PAVE, PECOS, CAQH, and CPPA forms?

Experience:

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

Work Location: In person

Salary : $22 - $28