Billing & Credentialing Specialist

Position Overview

We 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.

Key Responsibilities

Claims Processing & Revenue Cycle Management

• Submit, correct, and track claims to ensure timely reimbursement.
• Monitor claim status and manage rejections, denials, resubmissions, and appeals.
• Address overpayments, underpayments, and recoupments within required timelines.
• Process insurance write-offs in compliance with company policy.
• Collaborate with third-party billing vendors (e.g., QualiFacts) to resolve escalated billing issues.
• Maintain updated billing rules to improve efficiency.

Client Billing & Accounts Management

Credentialing & Provider Enrollment

Compliance, Data Integrity & Reporting

Qualifications