Billing and Credentialing Specialist

Position Summary

The Billing and Credentialing Specialist is responsible for the accurate and timely submission of claims, payment posting, resolution of patient billing inquiries, and comprehensive provider credentialing and enrollment activities. This role supports the full revenue cycle by ensuring claims accuracy, maintaining active and compliant provider enrollments, and managing payer relationships. The position ensures compliance with payer guidelines, FQHC billing regulations, Sliding Fee Scale (SFS) documentation, and Good Faith Estimate (GFE) requirements under the No Surprises Act. The specialist plays a key role in revenue integrity by maintaining accurate provider records, credentialing files, and payer enrollments.

Responsibilities and Duties

Billing & Revenue Cycle

• Submit clean and accurate claims to commercial, Medicare, Medicaid, and other third-party payers via electronic and paper methods. 


• Accurately post payments from insurance companies and patients; reconcile discrepancies in a timely manner. 


• Generate and distribute patient statements in accordance with billing cycles. 


• Address and resolve billing inquiries from patients, payers, and internal departments. 


• Estimates to uninsured and self-pay patients. 


• Monitor accounts receivable, follow up on unpaid claims, and submit corrected claims or appeals as necessary. 


• Document and track collection activities; escalate delinquent accounts per policy. 


• Maintain compliance with HIPAA and all applicable federal and state billing regulations. 

Credentialing & Provider Enrollment

• Prepare and submit initial and recredentialing applications for providers with commercial payers, Medicare, and Medicaid. 


• Maintain accurate and up-to-date provider credentialing files, including licenses, certifications, DEA registrations, and malpractice insurance. 


• Monitor credentialing and enrollment timelines to ensure providers remain active and billable without interruption. 


• Track and follow up on pending applications, revalidations, and payer requests for additional information. 


• Maintain information within credentialing systems (e.g., CAQH) and ensure data accuracy and attestations are current. 


• Ensure compliance with payer-specific credentialing requirements and FQHC regulations. 


• Assist with payer audits, site visits, and credentialing-related compliance reviews. 


• Maintain and update provider rosters and payer enrollment records to ensure alignment with billing systems. 


• Stay current with FQHC billing practices, payer guidelines, coding updates, and credentialing requirements. 


• Promote the principles of healthcare integration and the Patient-Centered Medical Home (PCMH).

Qualifications

Knowledge, Skills, and Abilities

• Working knowledge of medical billing practices, including coding (ICD-10, CPT) and payer guidelines.


• Familiarity with commercial, Medicaid, and Medicare billing procedures.


• Proficiency in electronic medical records (EMR) and billing software.


• Strong organizational skills and attention to detail.


• Excellent communication and customer service skills.


• Ability to understand and follow written and verbal instructions.


• Ability to manage multiple priorities in a fast-paced environment.


• Professional telephone etiquette and interpersonal skills.


• Ability to maintain confidentiality and handle sensitive information appropriately.

Education

• High school diploma or equivalent required.


• Certification in Medical Billing and Coding preferred.


• Technical or vocational training in medical billing is a plus.

Experience

• Minimum of one (1) year of experience in medical billing and credentialing/enrollment preferred. Equivalent practicum experience may be considered.

 Physical Demands

• Must be able to perform essential duties with or without reasonable accommodation.


• Frequent sitting, standing, and use of standard office equipment.


• Manual dexterity sufficient to operate a computer keyboard and calculator.


• Occasional travel to other MAP locations may be required.

Work Environment

• Office-based clinical/business environment within a healthcare setting.


• Work is primarily performed with patients, providers, payers, and internal staff via phone, email, and in person.


• Fast-paced environment with deadlines tied to billing cycles and credentialing timelines.

Disclaimer

The above is intended to describe the job functions, the general supplemental functions and the essential requirements for the performance of this job. It is not to be construed as an exhaustive statement of supplemental duties, responsibilities, or non-essential requirements.

Medical Associates Plus is an Equal Opportunity Employer and does not discriminate against any employee or applicant because of race, color, sex, age, national origin, religion, sexual orientation, gender identity and/or expression, veteran status, basis of disability or any other federal, state or local protected class.