Credentialing and Medical Billing Specialist

Job Summary
Elevate Workforce Solutions is seeking a highly skilled and detail-oriented Credentialing and Medical Billing Specialist to join our dynamic team. This individual will manage credentialing and billing processes for 1199, Fidelis, HealthFirst, and other insurance providers while overseeing claims management for therapy services. The ideal candidate will have extensive knowledge of billing platforms, possess excellent organizational and communication skills, and be adept at managing tasks with precision and timeliness.

Key Responsibilities
Credentialing:
Manage the credentialing and re-credentialing processes with 1199, Fidelis, HealthFirst, and other insurance providers.
Maintain up-to-date records and documentation for all insurance contracts.
Act as the primary liaison with insurance providers to resolve any credentialing issues or discrepancies.
Ensure compliance with federal and state regulations and standards for credentialing.

Medical Billing:
Accurately prepare and submit claims for therapy services, ensuring adherence to insurance guidelines and policies.
Perform regular audits to ensure claim accuracy and completeness.
Manage denied claims, investigate causes, and resolve billing discrepancies in a timely manner.
Track and report accounts receivable status, identifying trends and addressing issues to minimize unpaid claims.
Administrative and Communication:
Maintain proficiency in billing platforms and electronic health records (EHR) systems.
Communicate with clients, providers, and insurance companies regarding billing inquiries and resolutions.
Generate detailed reports on billing metrics, including payment trends, claim denial rates, and insurance reimbursements.

Qualifications
Education and Experience:
Bachelor’s degree in healthcare administration, finance, or related field (preferred).
Minimum 3 years of experience in medical billing and credentialing, particularly with 1199, Fidelis, and HealthFirst insurance.
Prior experience managing claims for therapy services is highly desirable.

Skills and Competencies:
Proficiency in billing platforms and electronic health record (EHR) systems.
Expert-level understanding of insurance credentialing and claims management processes.
Strong command of written and spoken English.
Exceptional organizational skills with keen attention to detail.
Ability to handle multiple tasks while meeting deadlines.
Strong problem-solving skills and ability to work independently.

Personal Attributes:
Highly motivated and proactive.
Excellent interpersonal and communication skills.
Reliable, punctual, and capable of maintaining confidentiality.

Benefits
Competitive pay and performance-based bonuses.
Flexible working schedule.
Opportunities for professional growth within a fast-growing company.
Access to wellness initiatives, including yoga and mindfulness programs.

How to Apply
Please submit your resume and cover letter detailing your relevant experience and explaining why you’re the perfect candidate for this role. Applications should be sent to Upgrade to see actual info and cc Upgrade to see actual info