Billing Credentialing Specialist

divh2Billing Credentialing Specialist/h2pWe 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./ph3Key Responsibilities/h3pClaims Processing Revenue Cycle Management/pulliSubmit, correct, and track claims to ensure timely reimbursement./liliMonitor claim status and manage rejections, denials, resubmissions, and appeals./liliAddress overpayments, underpayments, and recoupments within required timelines./liliProcess insurance write-offs in compliance with company policy./liliCollaborate with third-party billing vendors (e.g., QualiFacts) to resolve escalated billing issues./liliMaintain updated billing rules to improve efficiency./li/ulpClient Billing Accounts Management/pulliVerify insurance coverage monthly and ensure client demographic/insurance information is current in the EHR./liliRespond promptly and professionally to client billing inquiries./liliManage accounts receivable, support collections, and document billing activity./liliMaintain billing logs, internal notes, and compliance documentation./li/ulpCredentialing Provider Enrollment/pulliManage credentialing and recredentialing for providers with Ohio Medicaid and private insurance carriers./liliTrack credentialing application statuses, revalidations, renewals, and provider rosters./liliEnsure timely submission of all required paperwork and documentation./liliCommunicate with carriers to resolve credentialing or enrollment-related issues affecting billing./liliCollaborate with providers and administrative staff to ensure smooth onboarding and compliance./li/ulpCompliance, Data Integrity Reporting/pulliEnsure compliance with Ohio Administrative Code (OAC), Ohio Revised Code (ORC), Medicaid requirements, and HIPAA standards./liliMaintain EHR data hygiene, accuracy, and compliance (systems include inSync or CareLogic)./liliSupport audits, compliance reviews, and credentialing-related billing checks./liliGenerate financial and credentialing reports to monitor performance, trends, and outstanding issues./li/ulh3Qualifications/h3ulli23 years of experience in medical billing, credentialing, or revenue cycle management (behavioral/mental health preferred)./liliStrong understanding of Ohio Medicaid billing guidelines and third-party payer processes./liliExperience managing provider credentialing and enrollment./liliProficiency in EHR systems such as inSync or CareLogic./liliKnowledge of CPT/ICD-10 coding, insurance authorization, and HIPAA compliance./liliExcellent organizational, communication, and problem-solving skills./liliAbility to analyze data, identify trends, and recommend improvements./liliHigh level of accuracy, attention to detail, and ability to meet deadlines in a remote environment./liliCommitment to using inclusive, affirming, and culturally responsive language./li/ul/div