Outpatient Credentialing Specialist/ AR Specialist

Outpatient Credentialing Specialist/ AR Specialist 3.6 3.6 out of 5 stars Description We are seeking a detail-oriented and experienced Outpatient Part B Credentialing Specialist / AR Specialist to support our revenue cycle operations. This role is responsible for managing provider credentialing and enrollment for Medicare Part B and commercial payers, while also overseeing accounts receivable follow-up to ensure timely reimbursement. The ideal candidate has strong knowledge of outpatient billing, Medicare regulations, and payer enrollment processes. Key Responsibilities Credentialing & Enrollment Manage Medicare Part B provider enrollment, revalidations, and updates through PECOS and other payer portals Submit and track provider credentialing applications with commercial and government payers Maintain CAQH profiles and ensure accuracy of provider data Monitor credentialing expirations and ensure timely renewals Communicate with payers regarding application status, missing documentation, and follow-ups Maintain provider credentialing files in compliance with regulatory standards Accounts Receivable (AR) Management Perform timely follow-up on unpaid and underpaid outpatient claims Review denials and rejections, identify root causes, and initiate corrective action Submit appeals with appropriate documentation Post payments and adjustments accurately when needed Work closely with billing and coding teams to resolve claim issues Maintain aging reports and meet established AR performance goals Identify trends impacting reimbursement and report to leadership Skills, Knowledge and Expertise Minimum 2-3 years of experience in Medicare Part B credentialing and/or outpatient AR Strong knowledge of Medicare Part B billing guidelines and outpatient reimbursement Experience with PECOS, CAQH, NPPES, and payer portals Familiarity with EHR and practice management systems Understanding of CPT, ICD-10, and HCPCS coding basics Strong analytical, organizational, and problem-solving skills Excellent written and verbal communication skills Ability to manage multiple priorities and meet deadlines Preferred Qualifications Experience in outpatient therapy, physician practice, or rehab settings Knowledge of Medicare LCD/NCD policies CPC or CRCR certification (preferred but not required) Key Competencies Detail-oriented and compliance-focused Strong follow-through and persistence with payers Confidentiality and HIPAA compliance Team-oriented with ability to work independently Benefits Flexible Scheduling. CEU and State Licensure Reimbursements. 13 Days of PTO and 6 Paid Holidays. Plus one free Floating Holiday every year! Internal Growth and Leadership Opportunities. Mental Wellbeing Support Program. Health, Dental, and Vision. Retirement benefits (including 401k company match). About TMC We specialize in delivering innovative solutions and exceptional services to meet the diverse needs of our clients. With a strong commitment to quality and customer satisfaction, we strive to exceed expectations and drive success in every project we undertake.