Billing & Credentialing Specialist

Job Description

Job Description

Billing & Credentialing Specialist. MUST RESIDE IN DENVER,CO AREA

Pay equivalent : $50,000-$60,000/annually experience and credential dependant

Location: 8790 W. Colfax Ave Lakewood

Employment Type: Part-time with potential to become Full -time

Schedule: TBD

Position Summary

Denver Recovery Group (DRG) is seeking an experienced Billing & Credentialing Specialist to join our growing team. This position is responsible for managing provider credentialing and enrollment, with a strong emphasis on Colorado Medicaid (HCPF) requirements. The ideal candidate will have extensive experience with provider enrollment, medical billing, revenue cycle management, and resolving payer issues to ensure timely reimbursement and compliance with state and federal regulations.

Essential Duties and Responsibilities: Colorado Medicaid Enrollment

&degree; Complete and manage provider enrollments, revalidations, updates, and affiliations through the Colorado interChange Provider Portal.

&degree; Monitor application status and resolve enrollment issues promptly.

&degree; Maintain accurate provider records and ensure timely renewals.

Provider Credentialing: &degree;Perform primary source verification of provider credentials, including:

&degree; State licensure

&degree; DEA registrations

&degree; Board certifications

&degree; Education and training

&degree; Professional references

&degree; Maintain credentialing files and ensure compliance with regulatory and payer requirements.

&degree; Coordinate credentialing and recredentialing with commercial insurance carriers as needed.

Compliance & Reporting

Maintain compliance with Colorado Department of Health Care Policy and Financing (HCPF), CMS, HIPAA, and payer requirements.

Stay informed of changes in Medicaid billing, credentialing, and reimbursement policies.

Prepare reports related to credentialing status, enrollment activity, and billing performance.

Qualifications: Required:

Associate's degree in Healthcare Administration, Business Administration, Medical Billing, or a related field, or equivalent work experience.

2–4 years of experience in provider enrollment or payer credentialing.

Demonstrated experience working with Colorado Medicaid (HCPF) provider enrollment and billing.

Strong understanding of:

&degree; Colorado HCPF policies and procedures

&degree; RAE Requirements and Contracting

&degree; Third Party Insurance

&degree; CAQH provider data management

&degree; CMS regulations

&degree; CPT, ICD-10, and HCPCS coding standards

Experience working with Electronic Health Record (EHR) and practice management systems.

Excellent organizational, analytical, and problem-solving skills.

Strong written and verbal communication skills.

Ability to manage multiple priorities while meeting deadlines with a high degree of accuracy.

&degree; Preferred Certifications

Certified Provider Credentialing Specialist (CPCS)

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All candidates selected for employment must successfully complete a pre-employment drug screening as a condition of employment. Employment offers are contingent upon satisfactory completion of the required screening. DRG reserves the right to rescind an employment offer if the candidate does not successfully pass the required pre-employment drug screening.