Billing and Credentialing Specialist

BILLING AND CREDENTIALING SPECIALIST

JOB DESCRIPTION

Reports To: BUSINESS OPERATIONS DIRECTOR

Status: Hybrid Hourly (24-29 Hours weekly) 

POSITION SUMMARY 

The Billing and Credentialing Specialist is responsible for the accurate, timely, and consistent execution of Reach Counseling's clinical billing, payer credentialing, payment processing, insurance coordination, and accounts receivable collection activities. This position plays a critical role in supporting the agency's financial sustainability by ensuring services are appropriately credentialed, claims are submitted accurately, payments are processed and reconciled, and outstanding balances receive timely follow-up.

The Specialist serves as a primary operational contact for insurance companies, third-party payers, clinicians, clients, and internal departments regarding credentialing, billing, reimbursement, and payment-related matters. The role maintains organized documentation, monitors outstanding claims and accounts, identifies discrepancies, resolves routine billing barriers, and escalates complex issues to the Business Operations Director as appropriate.

Working collaboratively with clinical and operational teams, the Billing and Credentialing Specialist helps ensure that Reach's systems and processes support timely reimbursement, responsible financial stewardship.

ESSENTIAL DUTIES AND RESPONSIBILITIES 

The following Outcomes describe the primary accountabilities and expected outcomes of the position. Other duties may be assigned based on organizational needs.

1. Provider Credentialing and Payer Enrollment

• Maintain active, accurate, and appropriate credentialing and enrollment status across applicable insurance networks.
• Credentialing applications, renewals, provider updates, and required documentation are completed accurately and within established deadlines.
• Credentialing barriers and enrollment delays are proactively resolved to support provider participation, service continuity, and timely reimbursement.

2. Clinical Billing and Revenue Cycle Management

• Eligible clinical services are accurately, completely, and timely converted into submitted insurance claims.
• Billing discrepancies, rejected claims, denials, and unbilled services are identified, addressed, and resolved to minimize preventable revenue loss.
• Billing activity is consistently monitored to ensure claims progress through the reimbursement cycle and outstanding items receive appropriate follow-through.

3. Payment Processing and Reconciliation

• Insurance and client payments are accurately processed, posted, and reflected in the appropriate accounts and financial systems.
• Payment discrepancies, unapplied payments, underpayments, and overpayments are identified, investigated, and resolved.
• Payment records and supporting documentation are maintained accurately and in accordance with organizational financial controls and procedures.

4. Insurance Payer Coordination

• Effective working relationships are maintained with insurance companies and payer representatives to support credentialing, claims processing, and reimbursement.
• Payer-related inquiries, claim issues, enrollment concerns, and reimbursement barriers receive timely communication and resolution.
• Payer requirements, changes, and recurring issues are monitored and communicated to leadership to support compliance and uninterrupted reimbursement.

5. Accounts Receivable and Collections

• Insurance and client accounts receivable are actively monitored, with consistent attention to aging balances and outstanding claims.
• Appropriate collection efforts, payer follow-up, and client payment communications are completed and documented to maximize collectible revenue.
• Outstanding account trends, collection barriers, and unresolved balances are identified, addressed, and escalated to leadership as appropriate.

Organizational expectations: Confidentiality, collaboration, professional conduct, and adherence to Reach’s mission and values apply across all areas of responsibility.

QUALIFICATIONS 

• Bachelor's degree preferred in business administration, finance, accounting, nonprofit management, healthcare administration, public administration, or a related field; equivalent combination of relevant education and progressively responsible experience may be considered. 
• Bilingual (Spanish and English) speaking preferred.
• Progressively responsible experience in business operations, financial administration, healthcare or nonprofit operations, billing, budgeting, or a related area; leadership or supervisory experience preferred. 
• Working knowledge of billing processes, payment tracking, reconciliations, internal controls, budgeting, audit preparation, records management, and operational compliance. 
• Experience with payer credentialing, provider enrollment, healthcare billing, Medicaid, private insurance, or behavioral health operations preferred. 
• Demonstrated ability to develop and improve systems, document procedures, manage deadlines, identify risk, solve problems, and maintain accurate records. 
• Develop, and sustain clinical record system to support efficient and compressive billing practices.
• Ability to analyze operational and financial information, identify trends or discrepancies, and communicate clear findings and recommendations. 
• Ability to work independently in a deadline-driven environment with evolving priorities, frequent interruptions, and occasional urgent needs. 
• Proficiency with Microsoft Office applications and the ability to learn and effectively use billing, financial, electronic health record, data, and communication platforms. 
• Ability to handle confidential and sensitive client, employee, donor, financial, and organizational information with sound judgment and discretion. 

PHYSICAL AND WORK ENVIRONMENT REQUIREMENTS 

• Employees must work their workdays spanning at least 4 days within the business week Monday – Friday.
• Ability to independently enter and move within offices for required meeting, community facilities, and other work locations, including use of stairways. 
• Ability to occasionally lift or move up to 40 pounds. 
• Frequent computer use, sitting, standing, walking, and conversation for prolonged periods. 
• Ability to operate standard office equipment and work effectively in environments with frequent interruptions or distractions. 
• Regular business hours are generally Monday through Friday; flexibility and occasional evening or weekend responsibilities are required based on operational, community, fundraising, or organizational needs. 

SUCCESS MEASURES 

• Accurate, timely, well-documented billing, payment, deposit, credentialing, budgeting, records, and operational processes. 
• Reliable internal controls, clear procedures, appropriate separation of duties, and timely correction of identified risks or discrepancies. 
• Timely payer enrollment and recredentialing with organized records, deadline tracking, and effective follow-up. 
• Useful operational and financial information that supports leadership decisions, program planning, compliance, and long-term sustainability. 
• Efficient, secure, and responsive technology, records, vendor, and administrative support systems. 
• Effective coaching, accountability, development, and support of assigned operational staff. 
• Timely completion of budgets, audits, reports, renewals, corrective actions, and organizational commitments within the role's scope.

Pay: $22.00 - $26.00 per hour

Expected hours: 24.0 – 29.0 per week

Benefits:

• Flexible schedule
• Paid time off

Work Location: Hybrid remote in Neenah, WI 54956

Salary : $22 - $26