What are the responsibilities and job description for the Billing and Credentialing Specialist position at Luna Del Valle HCS?
Benefits:
- Competitive salary
- Health insurance
- Paid time off
Position Overview
Twilight Physician Group is seeking a highly organized and detail-oriented Billing and Credentialing Specialist to support a growing, innovative medical practice. This role is responsible for overseeing all aspects of medical billing, revenue cycle management, payer credentialing, and provider enrollment, ensuring financial sustainability and regulatory compliance across multiple care models. The ideal candidate thrives in a dynamic environment that integrates primary care, integrative medicine, access care, and facility-based services (e.g., assisted living).
Key Responsibilities
Billing & Revenue Cycle Management
• Manage full-cycle medical billing operations:
- Charge entry, coding review (CPT, ICD-10, HCPCS)
- Claims submission (electronic and paper)
- Payment posting and reconciliation
• Monitor and follow up on:
- Denied or rejected claims
- Underpayments and payer discrepancies
• Optimize accounts receivable (A/R) performance:
- Reduce days in A/R
- Improve clean claim rate
• Verify patient insurance eligibility and benefits
• Ensure compliance with:
- CMS guidelines
- Commercial payer requirements
- New Mexico Medicaid policies
• Generate regular financial and billing reports:
- Revenue trends
- Denial patterns
- Provider productivity metrics
Credentialing & Provider Enrollment
• Manage initial and ongoing credentialing for all providers (MDs, PAs, NPs, integrative practitioners where applicable)
• Complete and track:
- CAQH profiles and attestations
- Payer applications and revalidations
• Maintain provider enrollment with:
- Medicare
- Medicaid (New Mexico-specific)
- Commercial payers
• Track credentialing timelines to prevent revenue disruption
• Maintain accurate provider records, licenses, DEA registrations, and malpractice documentation
• Support onboarding of new providers to ensure rapid go-live readiness
Compliance & Documentation
• Ensure adherence to:
- HIPAA regulations
- Billing compliance standards
- Audit readiness (internal and external)
• Maintain documentation for:
- Credentialing files
- Payer communications
- Contracts and reimbursement rates
Operational Support
• Collaborate with:
- Clinical leadership
- Front desk staff
- Practice management team
• Assist with:
- Workflow optimization
- EHR/practice management system improvements
• Support implementation of:
- New service lines (e.g., integrative medicine, cash-pay services, memberships, medical marijuana evaluations)
Qualifications
Required
• 2–5 years of experience in medical billing and/or credentialing
• Strong knowledge of:
- CPT, ICD-10, HCPCS coding systems
- Insurance claims processes
- Medicare and Medicaid billing
• Experience with payer credentialing and provider enrollment
• Proficiency with:
- EHR and billing systems (e.g., Athenahealth, Kareo, eClinicalWorks, or similar)
• Strong attention to detail and organizational skills
Preferred
• Experience in multi-service or hybrid practice models (primary care specialty cash-pay)
• Familiarity with:
- Integrative/functional medicine billing
- Direct pay, concierge, or membership-based models
- Assisted living facility (ALF) billing
• Certification:
- Certified Professional Biller (CPB)
- Certified Professional Coder (CPC)
Key Competencies
• Analytical thinking and problem-solving
• Strong communication and follow-through
• Ability to manage multiple priorities
• High level of integrity and confidentiality
• Process improvement mindset
Compensation & Benefits
• Competitive salary (based on experience)
• Opportunities for growth within a rapidly expanding organization
• Flexible work environment (potential hybrid/remote components)
• Continuing education support
About Twilight Physician Group
Twilight Physician Group is a forward-thinking medical organization focused on delivering high-quality, patient-centered care across the continuum, including:
• Primary care
• Integrative and functional medicine
• Access care
• Assisted living facility care
• Innovative service lines (e.g., wellness, medical cannabis evaluations)
Our mission is to create a sustainable, collaborative, and healing-focused healthcare model that supports both patients and clinicians.
Submit your resume to apply today!
www.twilightmds.com
Twilight Physician Group is seeking a highly organized and detail-oriented Billing and Credentialing Specialist to support a growing, innovative medical practice. This role is responsible for overseeing all aspects of medical billing, revenue cycle management, payer credentialing, and provider enrollment, ensuring financial sustainability and regulatory compliance across multiple care models. The ideal candidate thrives in a dynamic environment that integrates primary care, integrative medicine, access care, and facility-based services (e.g., assisted living).
Key Responsibilities
Billing & Revenue Cycle Management
• Manage full-cycle medical billing operations:
- Charge entry, coding review (CPT, ICD-10, HCPCS)
- Claims submission (electronic and paper)
- Payment posting and reconciliation
• Monitor and follow up on:
- Denied or rejected claims
- Underpayments and payer discrepancies
• Optimize accounts receivable (A/R) performance:
- Reduce days in A/R
- Improve clean claim rate
• Verify patient insurance eligibility and benefits
• Ensure compliance with:
- CMS guidelines
- Commercial payer requirements
- New Mexico Medicaid policies
• Generate regular financial and billing reports:
- Revenue trends
- Denial patterns
- Provider productivity metrics
Credentialing & Provider Enrollment
• Manage initial and ongoing credentialing for all providers (MDs, PAs, NPs, integrative practitioners where applicable)
• Complete and track:
- CAQH profiles and attestations
- Payer applications and revalidations
• Maintain provider enrollment with:
- Medicare
- Medicaid (New Mexico-specific)
- Commercial payers
• Track credentialing timelines to prevent revenue disruption
• Maintain accurate provider records, licenses, DEA registrations, and malpractice documentation
• Support onboarding of new providers to ensure rapid go-live readiness
Compliance & Documentation
• Ensure adherence to:
- HIPAA regulations
- Billing compliance standards
- Audit readiness (internal and external)
• Maintain documentation for:
- Credentialing files
- Payer communications
- Contracts and reimbursement rates
Operational Support
• Collaborate with:
- Clinical leadership
- Front desk staff
- Practice management team
• Assist with:
- Workflow optimization
- EHR/practice management system improvements
• Support implementation of:
- New service lines (e.g., integrative medicine, cash-pay services, memberships, medical marijuana evaluations)
Qualifications
Required
• 2–5 years of experience in medical billing and/or credentialing
• Strong knowledge of:
- CPT, ICD-10, HCPCS coding systems
- Insurance claims processes
- Medicare and Medicaid billing
• Experience with payer credentialing and provider enrollment
• Proficiency with:
- EHR and billing systems (e.g., Athenahealth, Kareo, eClinicalWorks, or similar)
• Strong attention to detail and organizational skills
Preferred
• Experience in multi-service or hybrid practice models (primary care specialty cash-pay)
• Familiarity with:
- Integrative/functional medicine billing
- Direct pay, concierge, or membership-based models
- Assisted living facility (ALF) billing
• Certification:
- Certified Professional Biller (CPB)
- Certified Professional Coder (CPC)
Key Competencies
• Analytical thinking and problem-solving
• Strong communication and follow-through
• Ability to manage multiple priorities
• High level of integrity and confidentiality
• Process improvement mindset
Compensation & Benefits
• Competitive salary (based on experience)
• Opportunities for growth within a rapidly expanding organization
• Flexible work environment (potential hybrid/remote components)
• Continuing education support
About Twilight Physician Group
Twilight Physician Group is a forward-thinking medical organization focused on delivering high-quality, patient-centered care across the continuum, including:
• Primary care
• Integrative and functional medicine
• Access care
• Assisted living facility care
• Innovative service lines (e.g., wellness, medical cannabis evaluations)
Our mission is to create a sustainable, collaborative, and healing-focused healthcare model that supports both patients and clinicians.
Submit your resume to apply today!
www.twilightmds.com
Salary : $30