Medical Billing and Credentialing Specialist

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Pediatricz Now Primary Care, PLLC-CC, Corpus Christi, TX, US

About the Role:

The Billing/ Credentialing Specialist plays a critical role in ensuring the accuracy and timeliness of the organization's billing processes. This position is responsible for generating submitting claims, ERA'S, processing payments, and maintaining detailed financial records to support revenue collection. A medical biller acts as the crucial link between healthcare providers, patients and insurance companies to ensure healthcare services are properly reimbursed.

The role requires close collaboration with internal departments such as, customer service, and reaching out to payors to resolve billing discrepancies and answer client inquiries. The Billing Specialist contributes to the financial health of the company by ensuring that all billing activities comply with company policies and regulatory requirements. Ultimately, this role supports the organization's billing and customer satisfaction by managing billing operations efficiently and accurately.

Preferred Qualifications:

• Knowledge of relevant regulatory requirements and compliance standards related to billing.
• Background in customer service or account management to enhance client interactions.
• Certification in billing or accounting (e.g., Certified Professional Billing Specialist) is a plus.
• Ability to analyze billing trends and contribute to process improvements.
• Work experience:
  
  1 to 3 years of medical billing experience.
• High school diploma or equivalent.
• Proven experience in billing, claims and accounts receivable roles.
• Proficiency with billing software and Microsoft Office applications, especially Excel.
• Strong attention to detail and accuracy in handling financial data.
• Excellent communication skills to interact effectively with customers and internal teams.
• 1 Year experience preferred in credentialing
• Bilingual and Pediatric Billing experience preferred.

Responsibilities:

• Review billing data for accuracy and completeness, identifying and resolving discrepancies promptly.
• Process incoming payments and apply them to accounts in the billing system.
• Communicate with clients and internal teams to address billing questions, disputes, and adjustments.
• Maintain organized billing records and generate regular reports to support financial audits and management review.
• Processing initial and re-credentialing applications packets.
• Maintain Provider Profiles and monitor expiration dates.etc

Skills:

The Billing Specialist uses strong analytical skills daily to verify billing information and ensure accuracy in processing billing. Attention to detail is critical when reviewing contracts and payment records to prevent errors that could impact revenue. Communication skills are essential for resolving customer inquiries and collaborating with internal departments to address billing issues. Proficiency with billing software and Excel enables efficient data entry, report generation, and payment processing.

Additionally, problem-solving skills help the specialist identify discrepancies and implement solutions that improve billing workflows and customer satisfaction.