What are the responsibilities and job description for the Credentialing & Billing Specialist position at Northeast Orthopedics?
Job Overview
We are seeking a detail-oriented and proactive Credentialing & Billing Specialist to join our healthcare team. In this vital role, you will oversee the credentialing process for healthcare providers, ensuring all licenses, certifications, and credentials are current and compliant with industry standards. You will manage billing operations, verify insurance information, and ensure accurate claim submissions. Your expertise will support seamless payer enrollment and uphold healthcare compliance standards, contributing to the organization’s reputation for excellence in patient care and administrative integrity. This position offers an exciting opportunity to work within a dynamic healthcare environment committed to quality and regulatory adherence.
Duties
- Manage provider enrollment with various health insurance payers, including Medicare (CMS) and Medicaid programs, ensuring timely submission of applications in compliance with CMS regulatory guidelines.
- Maintain accurate databases of provider credentials, licensing information, and payer contracts using healthcare software applications and database management tools.
- Collaborate with providers to gather necessary documentation for credentialing and re-credentialing processes; review medical credentialing applications thoroughly for completeness and accuracy.
- Process billing claims efficiently using medical billing software, ensuring proper coding with medical terminology and adherence to health insurance policies.
- Monitor claim statuses, follow up on denials or rejections, and resolve billing discrepancies promptly to optimize revenue cycle management.
- Stay updated on evolving healthcare regulations such as CMS policies, NCQA standards, JCAHO requirements, and state-specific healthcare laws to ensure ongoing compliance.
Experience
- Proven experience in managed care environments or healthcare administrative roles with a focus on credentialing or billing processes.
- Strong knowledge of health insurance policies, payer enrollment procedures, and CMS regulatory compliance standards.
- Demonstrated proficiency with medical credentialing software applications and healthcare software systems used for database management and billing.
- Familiarity with medical terminology, contract management in healthcare settings, and healthcare compliance regulations including NCQA standards.
- Prior experience reviewing medical credentialing applications for accuracy and completeness; understanding of accreditation standards is highly desirable.
- Excellent organizational skills with the ability to handle confidential information securely while managing multiple tasks efficiently.
- Ability to interpret complex health regulation policies and apply them effectively within administrative workflows.
Join us in delivering exceptional administrative support that ensures our providers are credentialed correctly, claims are processed accurately, and our organization remains compliant with all relevant regulations!
Pay: From $1.00 per year
Work Location: In person