Medical Biller / Coder & Credentialing Specialist

Job Description

Job Description

Location: Tucson
Employment Type: Full-Time
Schedule: Monday – Friday
Our multi-location healthcare organization is seeking a highly organized professional who understands both medical billing/coding and provider credentialing and can support operational improvements within the revenue cycle.

Position Overview
The Medical Biller / Coder & Credentialing Specialist will manage key functions of the revenue cycle including coding accuracy, claims processing, payer credentialing, denial management, and provider enrollment.
This role works closely with providers, leadership, and clinical teams to ensure accurate billing, compliance with payer requirements, and efficient reimbursement processes.

Key Responsibilities
Medical Coding
Review provider documentation and assign accurate ICD-10, CPT, and HCPCS codes
Ensure coding complies with payer regulations and industry guidelines
Identify documentation gaps and communicate with providers when clarification is required
Support coding compliance and documentation improvement
Claims & Billing
Prepare and submit electronic claims through the practice management system
Monitor claim status and follow up on unpaid or denied claims
Investigate claim rejections and coordinate corrections with staff
Work with clearinghouses and insurance payers to resolve billing issues
Revenue Cycle Management
Monitor and manage accounts receivable
Track aging reports and follow up on outstanding balances
Investigate underpayments and payer discrepancies
Support efforts to improve clean claim rate and reduce days in A/R
Provider Credentialing & Enrollment
Manage provider credentialing and recredentialing with commercial and government payers
Maintain provider enrollment records and credentialing documentation
Track credentialing timelines and renewal deadlines
Coordinate payer enrollment applications and updates
Ensure provider information is accurately reflected in payer systems
Work with leadership and providers to ensure timely credentialing during onboarding
Compliance & Quality
Maintain compliance with billing regulations and payer policies
Support internal billing and coding audits
Ensure HIPAA compliance and protection of patient data
Reporting & Operational Support
Generate billing, collections, and credentialing status reports
Identify opportunities to improve billing workflows and revenue cycle performance
Collaborate with leadership to improve operational efficiency

Qualifications
Required
Minimum 3 years experience in medical billing, coding, or revenue cycle management
Experience with provider credentialing and payer enrollment
Strong knowledge of ICD-10, CPT, and HCPCS coding
Experience working with insurance payers and claim follow-up
Strong attention to detail and organizational skills
Preferred CPC, CCS, or equivalent coding certification
Experience in dermatology or outpatient specialty practices
Experience with Modernizing Medicine (ModMed EMA) or similar EMR systems
Knowledge of dermatology procedures, Mohs surgery billing, or cosmetic services
Key Competencies
Strong analytical and problem-solving abilities
Excellent attention to detail
Ability to manage multiple priorities and deadlines
Strong communication skills with clinical and administrative teams
Commitment to compliance and billing accuracy

What We Offer
Competitive compensation based on experience
Monday–Friday work schedule
Professional and collaborative work environment
Opportunity to support and improve revenue cycle operations within a growing healthcare organization

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