Medical Billing & Credentialing Specialist

Essential job responsibilities:

Revenue cycle support:

· Perform daily billing functions for ENT clinical services, audiology services, allergy department, and surgical procedures.

· Ensures accurate charge capture, coding and claims submission.

· Monitors accounts receivable denials and collections.

· Identify billing trends and assist in implementing performance improvements.

Credentialing & Recredentialing:

· Perform credentialing and recredentialing for the ENT providers and ASC facility.

· Maintain up-to-date records with Medicare, Medicaid, and commercial payers.

· Coordinate updates and submissions through credentialing platforms such as CAQH and PECOS.

Claims & Compliance:

· Submit facility and professional paper/electronic claims using UB-04 & CMS 1500 forms

· Review electronic remittance advice (ERA) and EOBs for payment accuracy.

· Resolve rejected or denied claims and prepare and submit appeals.

· Ensure compliance with HIPAA, CMS and Georgia specific billing regulations.

Team Collaboration & Support:

· Work closely with billing staff, providing assistance and sharing updates on coding changes, payer rules, and compliance requirements.

· Participate in audits and quality reviews as directed by the Practice Administrator.

Reporting & Analysis:

· Prepare monthly billing and AR reports for Administrator.

· Track clean claim ratios, underpayments, and payer performance.

· Recommend workflow or system improvements based on data insights.

Other Duties:

· Perform additional tasks as assigned by Administrator, or Providers.

Education:

High school diploma or general equivalency diploma (GED) with additional degree or certification as a CPB, CPC, CCA, CCS, CPSC or CMRS.

Experience:

3-5 years in medical billing or revenue cycles roles, including coding, and claim processing. Strong understanding of HIPAA and CMS guidelines and payer specific rules is also essential.

Performance Requirements:

Knowledge:

1. CPT, ICD-10, HCPCS coding systems

2. UB-04 and CMS 1500 claim formats

3. Medicare, Medicaid, and commercial payer guidelines

4. ASC billing and reimbursement structures.

5. Credentialing platforms (CAQH, PECOS, Availity)

Skills:

1. Proficiency in billing software and EHR systems (Athena)

2. Excel proficiency for reporting and analysis.

3. Strong written and verbal communication.

4. Organizational and time management skills.

Abilities:

1. Interpret payer contracts and reimbursement policies.

2. Lead credentialing processes accurately and timely.

3. Identify billing inefficiencies and recommend corrective actions.

4. Maintain confidentiality and uphold HIPAA standards.

5. Adapt to regulatory changes and payer updates.

Equipment Operated: Standard office equipment, computerized health information management system, vendor and payer software platforms etc.

Work Environment: Professional medical office setting with frequent interactions with patients, physicians, and internal departments. May involve dealing with sick or distressed patients.

Mental/Physical Requirements: Interruptions and multitasking are common, requiring strong focus and adaptability. High volume billing cycles and tight deadlines can create a fast-paced and occasionally stressful atmosphere. Extended periods of sitting while working on billing systems and reports. Occasional stooping, bending, and stretching to receive retrieve files or supplies. May need to lift paper files or office materials weighing up to 30 lbs. Must be able to operate a keyboard and office equipment efficiently. Normal visual acuity and hearing are essential for reading documents and communicating effectively.

Job Type: Full-time

Pay: $22.00 per hour

Benefits:

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

Experience:

• Credentialing: 3 years (Required)
• Medical billing: 3 years (Required)
• Medical Coding: 3 years (Required)

Work Location: In person

Salary : $22