Billing and Credentialing Specialist

Job Description

Job Description

Position Summary

The Billing Specialist (Billing & Credentialing) is responsible for the accurate and timely submission of claims, posting of payments, resolution of patient billing inquiries, provider credentialing and enrollment activities, and overall revenue cycle support. This role ensures compliance with payer guidelines, FQHC billing regulations, Sliding Fee Scale (SFS) documentation, and Good Faith Estimate (GFE) requirements under the No Surprises Act. The position supports revenue integrity by maintaining active provider enrollments and accurate payer files.

Responsibilities and Duties

• Submit clean and accurate claims to commercial, Medicare, Medicaid, and other third-party payers via electronic and paper methods.
• Accurately post payments from insurance companies and patients and reconcile discrepancies.
• Generate and distribute patient statements in alignment with billing cycles.
• Address and resolve billing inquiries from patients, payers, and internal departments.
• Assist patients with billing concerns, payment plans, and financial assistance options, including SFS applications.
• Ensure compliance with GFE requirements by preparing and providing Good Faith Estimates to uninsured and self-pay patients.
• Monitor and follow up on accounts receivable and submit corrected or appealed claims as needed.
• Maintain compliance with HIPAA and all applicable federal and state billing regulations.
• Document and track collection activities; escalate delinquent accounts appropriately.
• Participate in departmental meetings, training, and quality improvement initiatives.
• Stay current with FQHC billing practices, payer guidelines, and coding updates.
• Promotes the principles of healthcare integration and the Patient-Centered Medical Home.

Qualifications

Knowledge, Skills, and Abilities

• Working knowledge of medical billing practices, including coding (ICD-10, CPT) and payer guidelines.
• Familiarity with commercial, Medicaid, and Medicare billing procedures.
• Proficiency in electronic medical records (EMR) and billing software.
• Strong organizational skills and attention to detail.
• Excellent communication and customer service skills.
• Ability to understand and follow written and verbal instructions.
• Ability to manage multiple priorities in a fast-paced environment.
• Professional telephone etiquette and interpersonal skills.
• Ability to maintain confidentiality and handle sensitive information appropriately.

Education

• High school diploma or equivalent required.
• Certification in Medical Billing and Coding preferred.
• Technical or vocational training in medical billing is a plus.

Experience

• Minimum of one (1) year of experience in medical billing and credentialing/enrollment preferred. Equivalent practicum experience may be considered.

Physical Requirements

• Must be able to perform essential duties with or without reasonable accommodation.
• Frequent sitting, standing, and use of standard office equipment.
• Manual dexterity sufficient to operate a computer keyboard and calculator.
• Occasional travel to other MAP locations may be required.

Work Environment

• Office-based clinical/business environment within a healthcare setting.
• Work is primarily performed with patients, providers, payers, and internal staff via phone, email, and in person.
• Fast-paced environment with deadlines tied to billing cycles and credentialing timelines.

Disclaimer

The above is intended to describe the job functions, the general supplemental functions and the essential requirements for the performance of this job. It is not to be construed as an exhaustive statement of supplemental duties, responsibilities, or non-essential requirements.

Medical Associates Plus is an Equal Opportunity Employer and does not discriminate against any employee or applicant because of race, color, sex, age, national origin, religion, sexual orientation, gender identity and/or expression, veteran status, basis of disability or any other federal, state or local protected class.