Billing Credentialing Specialist
Job Title: Billing Credentialing Specialist
Reports to: Manager of Billing and Collections (AR and Claims)
Summary: The Billing Credentialing Specialist is responsible for reviewing, analyzing, and resolving professional billing claim edits and denials related to provider credentialing. This position researches claim issues, identifies root causes, coordinates necessary provider updates, and ensures timely resubmission of corrected or denied claims to maximize reimbursement and reduce recurring denials.
The Specialist works closely with Billing, Managed Care, Credentialing, and other internal departments to ensure provider information is accurate and current across payer, NPPES, and internal systems.
The ideal candidate is highly analytical, detail-oriented, organized, and proactive, with strong knowledge of professional medical billing, denial management, provider credentialing, and revenue cycle processes.
Essential Duties and Responsibilities:
- Review, analyze, and resolve professional billing claim edits and denials, identifying root causes a
