Billing & Credentialing Specialist

Position Overview

We are seeking a detail-oriented and proactive Billing & Credentialing Specialist to join our inclusive and affirming mental health practice. This role is critical to maintaining efficient revenue cycle operations by overseeing claims processing, client billing, and provider credentialing. The ideal candidate will have strong knowledge of Ohio Medicaid billing procedures, experience with third-party insurance, and the ability to manage credentialing processes from start to finish.

Key Responsibilities

Claims Processing & Revenue Cycle Management

• Submit, correct, and track claims to ensure timely reimbursement.
• Monitor claim status and manage rejections, denials, resubmissions, and appeals.
• Address overpayments, underpayments, and recoupments within required timelines.
• Process insurance write-offs in compliance with company policy.
• Collaborate with third-party billing vendors (e.g., QualiFacts) to resolve escalated billing issues.
• Maintain updated billing rules to improve efficiency.

Client Billing & Accounts Management

• Verify insurance coverage monthly and ensure client demographic/insurance information is current in the EHR.
• Respond promptly and professionally to client billing inquiries.
• Manage accounts receivable, support collections, and document billing activity.
• Maintain billing logs, internal notes, and compliance documentation.

Credentialing & Provider Enrollment

• Manage credentialing and recredentialing for providers with Ohio Medicaid and private insurance carriers.
• Track credentialing application statuses, revalidations, renewals, and provider rosters.
• Ensure timely submission of all required paperwork and documentation.
• Communicate with carriers to resolve credentialing or enrollment-related issues affecting billing.
• Collaborate with providers and administrative staff to ensure smooth onboarding and compliance.

Compliance, Data Integrity & Reporting

• Ensure compliance with Ohio Administrative Code (OAC), Ohio Revised Code (ORC), Medicaid requirements, and HIPAA standards.
• Maintain EHR data hygiene, accuracy, and compliance (systems include inSync or CareLogic).
• Support audits, compliance reviews, and credentialing-related billing checks.
• Generate financial and credentialing reports to monitor performance, trends, and outstanding issues.

Qualifications

• 2–3 years of experience in medical billing, credentialing, or revenue cycle management (behavioral/mental health preferred).
• Strong understanding of Ohio Medicaid billing guidelines and third-party payer processes.
• Experience managing provider credentialing and enrollment.
• Proficiency in EHR systems such as inSync or CareLogic.
• Knowledge of CPT/ICD-10 coding, insurance authorization, and HIPAA compliance.
• Excellent organizational, communication, and problem-solving skills.
• Ability to analyze data, identify trends, and recommend improvements.
• High level of accuracy, attention to detail, and ability to meet deadlines in a remote environment.
• Commitment to using inclusive, affirming, and culturally responsive language.