Medical Biller / Coder & Credentialing Specialist
About The Position
Our multi-location healthcare organization is seeking a highly organized professional who understands both medical billing/coding and provider credentialing and can support operational improvements within the revenue cycle. The Medical Biller / Coder & Credentialing Specialist will manage key functions of the revenue cycle including coding accuracy, claims processing, payer credentialing, denial management, and provider enrollment. This role works closely with providers, leadership, and clinical teams to ensure accurate billing, compliance with payer requirements, and efficient reimbursement processes.
Requirements
- Minimum 3 years experience in medical billing, coding, or revenue cycle management
- Experience with provider credentialing and payer enrollment
- Strong knowledge of ICD-10, CPT, and HCPCS coding
- Experience working with insurance payers and claim follow-up
- Strong attention to detail and organizational skills
- Strong analytical and problem-solving abilities
- Excellent attention to detail
- Ability to manage multiple priorities and deadlines
- Strong communication skills with clinical and administrative teams
- Commitment to compliance and billing accuracy
Nice To Haves
- CPC, CCS, or equivalent coding certification
- Experience in dermatology or outpatient specialty practices
- Experience with Modernizing Medicine (ModMed EMA) or similar EMR systems
- Knowledge of dermatology procedures, Mohs surgery billing, or cosmetic services
Responsibilities
- Medical Coding Review provider documentation and assign accurate ICD-10, CPT, and HCPCS codes
- Ensure coding complies with payer regulations and industry guidelines
- Identify documentation gaps and communicate with providers when clarification is required
- Support coding compliance and documentation improvement
- Prepare and submit electronic claims through the practice management system
- Monitor claim status and follow up on unpaid or denied claims
- Investigate claim rejections and coordinate corrections with staff
- Work with clearinghouses and insurance payers to resolve billing issues
- Monitor and manage accounts receivable
- Track aging reports and follow up on outstanding balances
- Investigate underpayments and payer discrepancies
- Support efforts to improve clean claim rate and reduce days in A/R
- Manage provider credentialing and recredentialing with commercial and government payers
- Maintain provider enrollment records and credentialing documentation
- Track credentialing timelines and renewal deadlines
- Coordinate payer enrollment applications and updates
- Ensure provider information is accurately reflected in payer systems
- Work with leadership and providers to ensure timely credentialing during onboarding
- Maintain compliance with billing regulations and payer policies
- Support internal billing and coding audits
- Ensure HIPAA compliance and protection of patient data
- Generate billing, collections, and credentialing status reports
- Identify opportunities to improve billing workflows and revenue cycle performance
- Collaborate with leadership to improve operational efficiency
Benefits
- Competitive compensation based on experience
- Monday–Friday work schedule
- Professional and collaborative work environment
- Opportunity to support and improve revenue cycle operations within a growing healthcare organization
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
