Medical Credentialing and Billing Specialist Innovative Management Alternatives, LLC - 1.0 Virginia Beach, VA Job Details Part-time | Full-time $21 - $24 an hour 5 hours ago Benefits Free parking Disability insurance Health insurance Dental insurance Paid time off Vision insurance Flexible schedule Life insurance Qualifications Contract management Multitasking Quality assurance Attention to detail Organizational skills Full Job Description Overview We are seeking a dynamic and detail-oriented Medical Credentialing and Billing Specialist to join our revenue cycle team. In this vital role, you will be responsible for managing the credentialing process for healthcare providers, ensuring compliance with all relevant regulations, and overseeing accurate billing procedures. Your expertise will help maintain seamless provider enrollment, uphold healthcare compliance standards, and optimize revenue cycle management. This position offers an exciting opportunity to contribute to a well-organized, compliant healthcare environment while supporting providers and patients alike. Duties Manage the entire medical credentialing process, including verifying provider credentials, reviewing applications, and ensuring timely enrollment with managed care organizations, payers, and regulatory bodies such as CMS (Centers for Medicare and Medicaid Services). Maintain and update provider databases with accurate credentialing information, ensuring compliance with NCQA (National Committee for Quality Assurance) standards and JCAHO (Joint Commission on Accreditation of Healthcare Organizations) requirements. Review medical credentialing applications thoroughly to verify qualifications, licensure, certifications, and adherence to state healthcare regulations. Oversee medical payer enrollment processes to facilitate smooth billing operations and ensure providers are properly registered with insurance companies. Utilize healthcare software applications and Microsoft Office tools to document credentialing activities, track application statuses, and generate reports. Ensure billing accuracy by managing claims submissions, verifying insurance coverage, and resolving billing discrepancies in accordance with health insurance policies and CMS regulatory compliance. Handle confidential information with the utmost discretion while maintaining compliance with healthcare privacy laws such as HIPAA. Collaborate with contract management teams to review provider agreements and ensure adherence to regulatory standards including CMS guidelines and accreditation standards like NCQA. Monitor changes in health regulation policies and update internal procedures accordingly to maintain ongoing compliance. Experience Proven experience in medical credentialing or healthcare administration within a clinical or hospital setting. Strong knowledge of managed care processes, health insurance policies, and state healthcare regulations. Familiarity with medical credentialing software systems and healthcare software applications used for database management and billing processes. Demonstrated understanding of CMS regulations, including Medicare and Medicaid requirements. Experience reviewing medical credentialing applications for accuracy, completeness, and regulatory compliance. Excellent organizational skills with the ability to manage multiple tasks efficiently in a fast-paced environment. Knowledge of healthcare accreditation standards such as JCAHO and NCQA is highly desirable. Ability to handle sensitive information confidentially while maintaining strict compliance with healthcare privacy laws. Join us in this impactful role where your expertise will directly support our mission of delivering exceptional revenue cycle and consulting services through meticulous credentialing practices and efficient billing operations!

Pay:

$21.00 - $24.00 per hour Expected hours: No more than 40.0 per week

Benefits:

Dental insurance Disability insurance Flexible schedule Free parking Health insurance Life insurance Paid time off Vision insurance

Work Location:

In person