Medical Billing & Insurance Credentialing Specialist

Job Description

Job Description

Benefits:

• 401(k)
• Employee discounts
• Health insurance
• Paid time off

Company: Nutritional Weight & Wellness Job Type: Full-Time Location: St. Paul, MN (Hybrid)

First, a little about us. We help people build healthier lives — and we think that starts with our own team. Weight & Wellness is a small, people-first nutrition practice where work/life balance is real, every team member matters, and no one is just a job title. If you've worked at a place where your effort went unnoticed, this will feel different.

Now, the role. We're bringing insurance billing in-house and need a skilled billing and credentialing specialist to own it. You'll work inside Healthie (EHR) and ClaimMD (EDI) — modern tools that handle a lot of the heavy lifting — but this role still requires a sharp, experienced person who knows how to read a denial, fix a claim, credential a provider, and talk to a client about their benefits without making their eyes glaze over.

What You'll Own:

• Day-to-Day:
  • Reviewing claims that Healthie auto-generates from appointments, then submitting them to ClaimMD — claim status updates automatically from there as remittances come in
  • Eligibility verification before appointments — ClaimMD covers most payers automatically; you'll handle the small number of exceptions through payer portals
  • Sending copay/coinsurance invoices once insurance remittance posts — amounts are pre-populated from the claim, not calculated by hand
  • Being the go-to person for front desk staff, clients, and providers when an insurance question comes up — and actually helping them understand the answer
• As-Needed:
  • Correcting and resubmitting denied or rejected claims using the reason codes ClaimMD surfaces (occasional formal appeal for more complex cases)
  • Periodic follow-up on aging accounts receivable balances
  • Tracking referral requirements and coordinating with clients and referring providers when it comes up
  • Handling prior authorizations for the occasional plan that requires one (not common for MNT, but it does come up with some Medicaid and HMO plans)
• Ongoing (not appointment-driven):
  • Credentialing new providers and keeping everything current — CAQH profiles, revalidations, payer enrollments, expiring documents

What We're Looking For:

• 4+ years of medical billing experience (nutrition or wellness setting is a bonus)
• ClaimMD or equivalent clearinghouse experience
• Solid CPT/ICD-10 coding knowledge, especially MNT codes (97802, 97803, 97804)
• Credentialing experience — CAQH, payer enrollment, the whole process
• Comfortable with payer portals (Availity, NaviNet, etc.)
• A communicator who can explain insurance in plain English
• Someone who runs their own work, hits their own deadlines, and doesn't need to be managed

What You'll Get:

• A team that actually respects your personal time
• Recognition for the work you do — in a small practice, good work doesn't go unnoticed
• Room to make this role your own and improve how things run
• Competitive pay based on your experience
• Health Insurance, Paid Time Off, 401K, Life Insurance, Employee Discount

Ready to apply? Send your resume and why you think you're a good fit for the role.

Flexible work from home options available.