Billing and Credentialing Specialist Irongate Behavioral Health LLC Tampa, FL Job Details Part-time $23

• $28 an hour 1 day ago Qualifications Appeals Commercial insurance knowledge Accounts receivable management Maintaining patient confidentiality Provider enrollment for medical credentialing Filing Medicaid health insurance ICD-10 Records management Attention to detail Medical insurance appeals management Medicaid regulations Medicaid Insurance claims appeal handling Time management

Full Job Description Billing & Credentialing Specialist Department:

Administration /

Revenue Cycle Reports To:

Administrator /

Executive Leadership Employment Status:

Full-Time Position Type:

Administrative / Non-Clinical Position Summary The Billing & Credentialing Specialist is responsible for managing the organization's insurance credentialing, payer contracting, enrollment, billing, claims management, and revenue-cycle activities. A primary focus of this position is establishing and maintaining contracts with Medicaid programs, Medicaid Managed Care Organizations (MCOs), and commercial/private insurance companies to expand the organization's payer network and ensure services can be billed accurately and efficiently. The Billing & Credentialing Specialist will manage the process from initial payer outreach and credentialing through contract execution, provider enrollment, claims submission, payment reconciliation, denial management, and ongoing payer compliance. The successful candidate will be highly organized, proactive, detail-oriented, and experienced in behavioral health and/or substance use disorder billing and credentialing. Essential Duties & ResponsibilitiesMedicaid Credentialing & Contracting Identify Medicaid programs and Medicaid Managed Care Organizations appropriate for the organization's services and service locations. Initiate and manage Medicaid provider enrollment and contracting applications. Complete organizational, facility, and individual provider enrollment applications as required. Maintain Medicaid provider IDs, enrollment records, revalidations, attestations, and associated documentation. Track applications from initial submission through approval and effective date. Follow up consistently with Medicaid agencies and MCO representatives regarding outstanding applications and contracting issues. Maintain knowledge of Medicaid billing requirements, covered services, authorization requirements, provider qualifications, and documentation standards. Monitor payer communications and regulatory changes that may affect enrollment, credentialing, reimbursement, or billing. Ensure Medicaid enrollment information remains current when providers, addresses, ownership, licenses, tax information, or organizational information changes. Private/Commercial Insurance Contracting Identify commercial insurance companies and health plans appropriate for organizational contracting. Contact payer network-development and provider-relations departments to initiate contracting. Complete Letters of Interest, credentialing applications, network participation applications, and contracting documentation. Negotiate or assist leadership with reviewing reimbursement rates, fee schedules, contract terms, authorization requirements, and network participation requirements. Track contract negotiations, credentialing status, effective dates, fee schedules, amendments, renewals, and termination provisions. Coordinate execution of payer agreements with organizational leadership. Maintain organized electronic copies of all payer contracts and associated correspondence. Verify that executed contracts are correctly loaded into payer systems before billing begins. Provider & Facility Credentialing Complete and maintain credentialing for the organization, facilities, and individual clinical providers. Maintain CAQH profiles and ensure information and documentation remain current. Manage provider enrollment, recredentialing, and payer roster updates. Maintain current copies of licenses, certifications, malpractice insurance, W-9s, NPIs, DEA registrations when applicable, resumes/CVs, board certifications, and other credentialing documents. Track credential expiration dates and initiate renewals before deadlines. Submit provider additions, terminations, demographic changes, and location updates to contracted payers. Maintain accurate credentialing files that are audit-ready. Insurance Billing Prepare and submit accurate claims to Medicaid, Medicaid MCOs, and commercial insurance companies. Review clinical documentation for billing readiness and communicate missing or incomplete documentation to appropriate staff. Verify that billed services correspond with authorized services, payer requirements, provider credentials, and appropriate billing codes. Ensure claims contain accurate CPT, HCPCS, ICD-10, modifiers, provider information, place-of-service information, units, and other required claim elements. Submit electronic and manual claims as required. Monitor clearinghouse reports and correct rejected claims promptly. Maintain payer-specific billing guidelines and procedures. Ensure claims are submitted within payer timely-filing requirements. Eligibility, Benefits & Authorizations Verify patient insurance eligibility before services are provided whenever required. Determine applicable benefits, deductibles, copays, coinsurance, authorization requirements, and limitations. Confirm behavioral health and substance use disorder benefits when applicable. Obtain or coordinate prior authorizations and continued-stay authorizations. Track authorization dates, units, visits, and expiration dates. Communicate authorization limitations and payer requirements to clinical and operational leadership. Accounts Receivable & Revenue Cycle Management Monitor all submitted claims through final adjudication. Work aging reports regularly, including 30

• 60• 90• and 120+ day accounts receivable.

Identify unpaid, underpaid, rejected, and denied claims. Research claim status directly with payers. Correct and resubmit claims when appropriate. Prepare reconsiderations and appeals for denied or incorrectly processed claims. Identify recurring denial trends and implement corrective processes. Post or reconcile insurance payments, adjustments, contractual allowances, and patient responsibility as assigned. Review Explanation of Benefits (EOB) and Electronic Remittance Advice (ERA) documentation for payment accuracy. Compare payer reimbursement against contracted rates and identify potential underpayments. Escalate significant reimbursement or contractual issues to leadership. Revenue Cycle Reporting Prepare routine reports for leadership including: Claims submitted Gross charges Payments received Outstanding accounts receivable Aging by payer Denial rates Rejection rates Clean-claim rates Payer-specific reimbursement Credentialing applications pending Contracts pending Providers awaiting enrollment Authorization issues Underpayments and payment discrepancies Provide leadership with clear updates regarding credentialing barriers, payer issues, outstanding revenue, and recommended corrective actions. Credentialing & Contracting Tracking Maintain a centralized payer and credentialing tracker that includes: Payer name Medicaid/MCO/commercial classification Network status Application date Credentialing status Contracting status Follow-up dates Assigned payer representative Provider IDs Group IDs Effective dates Recredentialing dates Fee schedules Contract documents Outstanding requirements Notes and next action required The Billing & Credentialing Specialist is expected to actively move applications forward rather than simply document their status. Compliance Responsibilities Maintain confidentiality and comply with HIPAA requirements. Follow federal and state Medicaid billing requirements. Maintain documentation supporting billed services. Assist with payer audits, Medicaid reviews, recoupment requests, and documentation requests. Immediately report suspected billing errors, overpayments, duplicate payments, or compliance concerns. Never knowingly submit claims for services that are undocumented, medically unnecessary, unauthorized when authorization is required, or otherwise non-billable. Coordinate with leadership and clinical staff to correct systemic billing or documentation issues.

Qualifications Required:

Experience with healthcare billing, credentialing, payer enrollment, or revenue-cycle management. Working knowledge of Medicaid and commercial insurance billing. Experience completing payer credentialing and enrollment applications. Knowledge of insurance eligibility, authorizations, claims, denials, appeals, and accounts receivable. Strong organizational and follow-up skills. Excellent written and verbal communication. Ability to manage multiple payer applications and deadlines simultaneously. Strong attention to detail and ability to maintain confidential information.

Preferred:

2+ years of healthcare billing and/or credentialing experience. Behavioral health, substance use disorder, detox, residential, IOP, PHP, outpatient, or mental health billing experience. Experience contracting with Medicaid Managed Care Organizations. Experience with commercial behavioral health insurance networks. Experience with CAQH and payer/provider portals. Experience with clearinghouses and electronic claims submission. Familiarity with CPT, HCPCS, ICD-10, modifiers, authorization requirements, and behavioral health billing codes. Experience reviewing payer contracts and fee schedules. Key Performance Expectations Performance will be evaluated based on measurable outcomes including timely completion of credentialing applications, payer-network expansion, credentialing turnaround times, clean-claim submission rates, denial reduction, timely denial resolution, accounts-receivable performance, successful collection of contracted reimbursement, and accuracy of payer and credentialing records. The employee is expected to maintain consistent follow-up with payers and provide leadership with clear visibility into outstanding contracting, credentialing, and revenue-cycle issues. Core Competencies The successful candidate should demonstrate: Strong ownership and accountability Persistent payer follow-up Revenue-cycle awareness Attention to detail Problem-solving ability Professional communication Time management Regulatory awareness Ability to prioritize high-value revenue issues Ability to work independently Ability to collaborate with clinical, admissions, operations, and leadership teams Position Goal The primary goal of the Billing & Credentialing Specialist is to build and maintain a strong payer infrastructure that allows the organization to become credentialed, secure appropriate Medicaid and commercial insurance contracts, bill accurately, collect reimbursement efficiently, reduce denials, and maintain a healthy revenue cycle. This position plays a critical role in ensuring that payer contracting translates into actual, collectible revenue while maintaining applicable billing and compliance standards.

Pay:

$23.00

• $28.

00 per hour

Work Location:

Hybrid remote in Tampa, FL 33604