Medical Billing and Credentialing Specialist

Job Overview We are seeking a detail-oriented Medical Billing and Credentialing Specialist to join our healthcare team. In this vital role, you will be responsible for managing the billing processes, ensuring accurate claim submissions, and maintaining provider credentials in compliance with industry standards. This position offers an exciting opportunity to contribute to a patient-centered environment where your skills directly impact quality care delivery.

Responsibilities Invoice Management:

Generate, review, and issue accurate invoices promptly, ensuring completeness of billing data.

Payment Processing:

Receive payments, post transactions, and manage accounts receivable databases.

Discrepancy Resolution:

Investigate and resolve billing errors, disputes, or inconsistencies.

Collections & Reporting:

Monitor outstanding accounts, contact customers regarding late payments, and provide regular reports on billing activity.

Compliance & Data Accuracy:

Verify billing information against contracts or Purchase Orders and ensure compliance with company policies.

Provider Maintenance:

Maintain up-to-date provider information, including licenses, certifications, and malpractice insurance.

Billing & Claims:

Prepare, review, and submit electronic claims to insurance companies.

Revenue Cycle Management:

Follow up on denied or unpaid claims and work accounts receivable to ensure payment.

Medical Billing:

Focuses heavily on insurance claims, ICD-10/CPT coding, and patient confidentiality (HIPAA).

Credentialing:

Initiate and track initial/re-credentialing applications for providers through CAQH, PECOS, and insurance portals. Maintains, monitors, and reports expirations of physician and practitioner licenses, insurance, TB test results, and other items as required

• Apply for and maintains compliant Federal, State, and other third-party payor professional provider numbers for all providers employed
• Provides oversight for and maintains the provider enrollment database for appropriate task management, provider communication of applications and files
• Completes necessary enrollment, re-enrollment, and change applications in an accurate and timely manner Skills Strong knowledge of managed care policies, insurance billing procedures, and reimbursement processes Proven experience working in a medical office environment with familiarity in medical terminology and coding practices Excellent organizational skills with the ability to manage multiple credentialing files simultaneously Ability to interpret complex insurance policies and NCQA standards to ensure compliance Effective communication skills for liaising with insurance companies, providers, and internal teams Familiarity with CAQH, state licensing, and payer portals.

Detail-oriented mindset with a focus on accuracy in data entry and documentation Proficiency in billing software systems, electronic health records (EHR), and Microsoft Office Suite High attention to detail, strong communication, and organization Benefits

• PPL and Six Paid Holidays
• Employer pays half of the health insurance for full-time employees at 35-40 hours a week.
• Dental, Vision Insurance
• IRA with 3% company match after 1 year

Pay:

$18.50 - $23.50 per hour

Experience:

Medical billing and

Credentialing:

2 years (Required) Ability to

Commute:

Rapid City, SD 57702 (Required)

Work Location:

In person