About the Role We are looking for an organized, dependable, and detail-oriented Insurance, Billing & Credentialing Specialist to join our growing pediatric therapy team. This position plays an important role in the financial and administrative operations of the clinic. The ideal candidate will have strong attention to detail, excellent follow-through, and the ability to manage multiple priorities while working with insurance companies, healthcare providers, families, vendors, and internal staff. The primary focus of this position will be medical billing, insurance verification, authorizations, credentialing, claims management, and company billing, while also providing general administrative support to ensure the clinic operates efficiently. Experience in medical billing, healthcare administration, insurance, credentialing, prior authorizations, or revenue cycle management is strongly preferred. About Us At Adaptive Pediatrics, we are a pediatric therapy clinic dedicated to helping children with autism and other developmental needs reach their full potential. We provide individualized Applied Behavior Analysis (ABA) therapy in a supportive, compassionate environment while partnering closely with families to create meaningful progress. Our team is committed to adapting our approach to each child's unique needs and providing high-quality care every step of the way. Key Responsibilities Medical Billing & Insurance Submit, monitor, and manage medical and insurance claims accurately and in a timely manner. Review claims for accuracy, completeness, and appropriate documentation prior to submission. Track submitted claims and follow up on outstanding, delayed, or unpaid claims. Research and resolve claim denials, rejections, payment discrepancies, and billing issues. Review Explanation of Benefits (EOBs), remittance information, and insurance payments. Post insurance payments and maintain accurate billing records. Monitor accounts receivable and assist with outstanding balances and collections. Communicate with insurance companies regarding claim status, payment issues, coverage questions, and other billing concerns. Identify recurring billing issues and communicate trends or concerns to management. Maintain accurate patient insurance and billing information within the company's systems. Assist with patient and family billing questions when needed. Maintain confidentiality and comply with HIPAA and applicable healthcare privacy requirements. Insurance Verification & Benefits Verify patient insurance eligibility and active coverage. Review insurance benefits, deductibles, copays, coinsurance, limitations, and authorization requirements. Confirm that services are covered under the patient's specific insurance plan. Maintain accurate documentation of insurance verification. Communicate insurance requirements and coverage information to appropriate staff. Monitor changes in insurance coverage and update patient records as needed. Follow up on insurance discrepancies or inactive coverage. Authorizations & Utilization Management Submit initial and ongoing treatment/service authorization requests to insurance companies. Monitor authorization status and follow up with payers regarding pending requests. Track authorization approval dates, expiration dates, approved units, and remaining units. Ensure authorization requests are submitted within required payer timelines. Gather and submit required clinical and administrative documentation for authorization requests. Communicate with clinical staff regarding documentation needed for authorizations. Identify upcoming authorization expirations and ensure renewals are initiated in a timely manner. Follow up on authorization denials, partial approvals, and requests for additional information. Maintain organized authorization records and documentation. Communicate payer requirements and changes to appropriate members of the clinical and administrative team. Provider Credentialing & Enrollment Coordinate initial and ongoing credentialing for BCBAs, RBTs, and other applicable providers. Complete and submit provider enrollment and credentialing applications to insurance companies and other payers. Maintain accurate provider information across payer portals and credentialing systems. Track credentialing applications from submission through approval. Monitor provider licenses, certifications, NPI information, CAQH profiles, insurance information, and other required credentials. Maintain and update CAQH and payer profiles as required. Track recredentialing deadlines and ensure submissions are completed before expiration dates. Follow up with insurance companies regarding pending credentialing and enrollment applications. Maintain organized credentialing records and documentation for each provider. Notify management of credentialing delays, enrollment issues, or upcoming deadlines that could affect billing or provider participation. Assist with adding new providers to applicable insurance plans and maintaining active payer participation. Company Billing & Administrative Finance Prepare, process, and track company invoices and business-related billing. Review vendor invoices and bills for accuracy and appropriate documentation. Assist with accounts payable and accounts receivable functions. Maintain organized records of company expenses, invoices, payments, and vendor documentation. Assist with purchasing and tracking supplies, equipment, and other business expenses. Communicate with vendors regarding invoices, billing discrepancies, payments, and account questions. Assist management with tracking recurring business expenses and outstanding invoices. Maintain accurate documentation for company billing and financial records. Assist with monthly administrative and financial reporting as needed. Administrative & Front Office Support Provide general administrative support to the clinic and management team. Assist with maintaining accurate patient, provider, insurance, and company records. Communicate professionally with families, employees, insurance representatives, vendors, and other external contacts. Assist with incoming calls, emails, and administrative requests as needed. Help ensure required forms, documentation, and records are completed and maintained. Assist with scheduling or coordinating administrative matters when necessary. Support clinic operations by identifying administrative issues and helping resolve them promptly. Maintain a professional, organized, and welcoming environment for families and staff. Perform other administrative duties as assigned. What We're Looking For The ideal candidate is someone who is highly organized, detail-oriented and dependable. This position requires someone who can manage multiple deadlines while maintaining accuracy and confidentiality. Preferred Qualifications Previous experience in medical billing, healthcare administration, insurance, credentialing, or prior authorizations. Experience working with health insurance companies and payer portals. Understanding of medical claims, EOBs, denials, and insurance terminology. Experience with provider credentialing and/or CAQH is a plus. Experience with accounts payable, accounts receivable, invoicing, or company billing. Experience working in a medical, behavioral health, pediatric therapy, ABA, or other healthcare setting is preferred. Strong computer and data-entry skills. Proficiency with Microsoft Office, including Excel and Outlook. Ability to learn and navigate multiple software systems and payer portals. Strong written and verbal communication skills. Excellent attention to detail and organizational skills. Ability to prioritize tasks and meet deadlines. Ability to maintain confidential patient and company information. Ability to work independently while also collaborating with clinical and administrative staff. The Right Fit We are looking for someone who takes ownership of their responsibilities and follows tasks through to completion. The right person will be comfortable making phone calls, communicating with insurance companies, researching billing issues, tracking deadlines, working with numbers and documentation, and managing multiple accounts at once. Because this position supports several areas of the business, flexibility and a willingness to learn are important. We value employees who are proactive, solution-oriented, and willing to identify problems rather than simply waiting for someone else to address them. Why Join Us? At our clinic, every administrative role directly contributes to our ability to provide quality services to the children and families we serve. You will have the opportunity to become an important part of the operational side of a growing pediatric therapy organization. We are looking for someone who wants to grow with the company, take ownership of their work, and help build efficient systems as our organization continues to expand. If you are organized, detail-oriented, and have a passion for healthcare administration, insurance, and billing, we would love to hear from you!

Pay:

$20.00 - $24.00 per hour Expected hours: 40.0 per week

Benefits:

401(k) Dental insurance Health insurance Paid time off Vision insurance

Work Location:

In person