Sr Provider Enrollment and RCM Specialist

Senior RCM and Provider Enrollment/Credentialing Specialist will play a vital role in ensuring our clients are accurately enrolled, credentialed, and fully set up for clean, efficient reimbursement and manage the entire revenue cycle process for professional billing, ensuring accurate coding, billing, and collections to optimize revenue flow. Your proactive approach and attention to detail will help streamline operations, improve cash flow, and enhance patient and client satisfaction.

What You’ll Do

• Manage provider enrollment with Medicare, Medicaid, and commercial payers
• Complete credentialing and re‑credentialing applications
• Maintain CAQH profiles and ensure all documentation is current
• Track expirables, licenses, certifications, and compliance requirements
• Set up and manage ERAs/EFTs for practices to ensure seamless payment posting
• Communicate with payers, providers, and internal teams to resolve issues
• Ensure timely follow‑up to avoid delays in reimbursement
• Review and analyze medical records to ensure accurate coding using CPT (Current Procedural Terminology), ICD-9, and ICD-10 codes for proper billing and reimbursement.
• Assign appropriate ICD coding based on documented diagnoses and procedures to facilitate precise billing and reporting.
• Process medical claims efficiently through EMR/EHR systems, ensuring compliance with insurance requirements and regulatory standards.
• Follow up on unpaid or denied claims by conducting thorough medical collections efforts, including resubmissions and appeals.
• Collaborate with medical office staff to verify patient information, insurance details, and ensure completeness of medical records for billing accuracy.
• Maintain detailed documentation of billing activities, claim statuses, and collection efforts to support audit readiness.

What You Bring

• Experience in provider enrollment, credentialing, or medical billing
• Strong organizational and communication skills
• Ability to manage multiple deadlines with precision
• Familiarity with payer portals, NPPES, PECOS, CAQH, ERA/EFT setup, and credentialing software
• Strong knowledge of medical terminology, medical records management, and healthcare documentation practices.
• Proficiency in medical coding including CPT coding, ICD-9, ICD-10, and ICD coding systems.
• Experience with medical billing processes and medical collection strategies to maximize revenue recovery.
• Familiarity with EMR/EHR systems such as Athena for claim submission, record keeping, and data management.

Benefits:

• 401(k) matching
• Dental insurance
• Flexible schedule
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: In person