Medical Billing & Provider Credentialing Specialist (Part-Time)

About Us

Virtue Medical Group is a growing family medicine practice dedicated to providing high-quality, patient-centered care. We are seeking an experienced and dependable Medical Billing & Provider Credentialing Specialist to oversee our revenue cycle and provider enrollment processes.

This role is ideal for someone who can independently manage medical billing, provider credentialing, insurance enrollments, and payer relationships while ensuring timely reimbursement and compliance.

Most work may be completed remotely; however, the selected candidate must be available to come to our Santa Ana office at least once per week to pick up billing documents, insurance correspondence, claim statements, and complete administrative tasks.

Key Responsibilities

Medical Billing & Revenue Cycle

• Submit and manage electronic claims using Tebra (formerly Kareo).
• Review, correct, and resubmit rejected or denied claims.
• Follow up with commercial insurance, Medicare, and Medi-Cal regarding unpaid claims.
• Post insurance payments, patient payments, adjustments, and write-offs.
• Monitor accounts receivable and aging reports to maximize collections.
• Verify insurance eligibility and benefits as needed.
• Review provider documentation in Practice Fusion to ensure accurate billing.
• Respond to patient billing inquiries professionally and promptly.
• Work closely with providers and front office staff to resolve billing and coding issues.

Provider Credentialing & Enrollment

• Manage provider credentialing and recredentialing for physicians and advanced practice providers.
• Maintain and update CAQH profiles.
• Complete provider enrollment with Medicare, Medi-Cal, and commercial insurance plans.
• Track credentialing renewals, provider licenses, DEA registrations, malpractice insurance, and board certifications.
• Ensure providers remain in-network and compliant with payer requirements.

Insurance Contracting & Provider Relations

• Coordinate payer enrollment and participation with contracted health plans.
• Maintain payer contracts and provider participation records.
• Assist with new provider onboarding and payer enrollment.
• Track contract effective dates, renewals, and required documentation.
• Communicate with insurance representatives to resolve enrollment, credentialing, and contracting issues.

Administrative

• Maintain organized provider and payer records.
• Generate billing and credentialing reports as requested.
• Ensure HIPAA compliance and patient confidentiality.
• Identify workflow improvements to increase billing efficiency and collections.

Qualifications Required

• Minimum 3 years of Family Medicine office medical billing experience.
• Minimum 2 years of provider credentialing experience.
• Hands-on experience with Tebra (formerly Kareo).
• Experience using Practice Fusion EHR.
• Strong understanding of CPT, ICD-10, HCPCS, and insurance billing.
• Experience with Medicare, Medi-Cal, and commercial insurance plans.
• Experience maintaining CAQH.
• Knowledge of provider enrollment and credentialing requirements.
• Strong organizational, communication, and problem-solving skills.
• Ability to work independently with minimal supervision.

Preferred

• Family Medicine or Primary Care experience.
• Experience with Southern California managed care plans (AltaMed, Optum, Regal, Prospect, Monarch, Health Net, Molina, Blue Shield Promise, CalOptima, etc.).
• CPC, CPB, or CPCO certification.
• Bilingual English/Vietnamese.

Pay: $23.00 - $28.00 per hour

Benefits:

• Flexible schedule

Application Question(s):

• Do you have at least 3 years of family medicine office medical billing experience?

Experience:

• billing: 3 years (Required)
• provider credentialing: 2 years (Required)
• Practice Fusion: 1 year (Required)
• provider credentialing and CAQH maintenance: 1 year (Required)
• provider enrollments: 1 year (Required)

Ability to Commute:

• Santa Ana, CA 92704 (Required)

Work Location: Hybrid remote in Santa Ana, CA 92704

Salary : $23 - $28