Certified Medical Coder responsible for coding diagnoses and procedures for billing and reporting. Ensuring compliance with coding guidelines and acting as a resource for medical staff.
About the role
- Credentialing and Medical Billing Specialist focusing on credentialing tasks and medical billing support in a hybrid role. Working from home, primarily during US business hours.
Responsibilities
- Complete and submit credentialing applications with supporting documentation to commercial payers.
- Monitor application progress/status and follow up with payers until the credentialing process is complete and the provider is in network.
- Update logs as necessary.
- Communicate with and notify staff of any missing or expired documentation.
- Update and re-attest (as necessary) provider credentials through CAQH, Availity, UnitedHealthcare, and other portals.
- Monitor the status of medical claims to ensure prompt and accurate payment.
- Research and resolve claim rejections and denials, implementing measures to prevent future occurrences.
- Document all account activities accurately and in a timely manner.
- Post adjustments and manage collections from various types of payers.
- Understand and apply Medicare, Medicaid, and commercial insurance eligibility requirements and payment methodologies.
- Correctly record contractual adjustments based on payer contracts and government regulations.
- Exhibit proficiency with billing systems and leverage all functionality to ensure the most efficient processing of claims.
- Call payers to get updates on claims and discuss the resolution of rejected claims.
- Answer patient questions about claims (where applicable.)
- Maintain up-to-date knowledge of changes in billing and coding guidelines, payer contracts, and government regulations.
- Collaborate with team members and providers, fostering a positive and productive work environment.
Requirements
- Minimum 5 years of hands-on experience in medical billing, with exposure to various EMR/EHR systems (e.g., Athena, Apero, etc.)
- OR Minimum 3 years of credentialing experience for US providers.
- Proven ability to work independently across different client environments and adapt quickly to new systems and workflows
- Strong understanding of medical billing procedures, insurance eligibility, payer requirements (Medicare, Medicaid, commercial), and denial resolution.
- Exceptional attention to detail and accuracy, especially for documentation and data entry.
- Strong organizational and project management skills; able to manage multiple credentialing and billing projects simultaneously.
- Effective written and verbal communication skills, including professional interaction with payers, providers, and patients.
- Willingness to learn and perform credentialing responsibilities in addition to medical billing duties.
Benefits
- Permanent work from home
- Following US Holidays
- Monday to Friday
- 7:00 AM – 4:00 PM Pacific Time / 11:00 PM to 8:00 AM Manila Time
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
No Education Requirement
Location requirements
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