Medical Billing, Credentialing & Coding Specialist

Join Our Team

We are a mission-driven behavioral health organization committed to empowering individuals on their recovery journey. We are seeking an experienced Medical Billing, Credentialing & Coding Specialist responsible for managing the full revenue cycle, including insurance billing, provider credentialing, and accurate medical coding for a behavioral health organization. This role ensures compliance with payer requirements, supports timely reimbursement, and maintains provider enrollment through CAQH and other credentialing platforms

Summary of Responsibilities:

Medical Billing & Revenue Cycle

·         Submit accurate and timely claims for mental health and substance use disorder services

·         Monitor claim status, resolve denials, and follow up on unpaid claims

·         Post payments and reconcile accounts receivable

·         Verify patient insurance eligibility and benefits

·         Ensure compliance with payer guidelines, including Medicaid, Medicare, and commercial plans

Credentialing & Provider Enrollment

·         Manage provider credentialing and recredentialing processes

·         Maintain and update CAQH profiles for all clinicians

·         Submit and track applications with insurance panels (Medicaid, Medicare, commercial payers)

·         Ensure licenses, certifications, malpractice insurance, and other required documents are current

·         Maintain credentialing database and audit readiness

Medical Coding

·         Assign accurate CPT, ICD-10-CM, and HCPCS codes for behavioral health services

·         Ensure documentation supports coding and billing compliance

·         Stay current with coding updates specific to mental health and substance abuse services

·         Conduct periodic chart audits to ensure coding accuracy

Compliance & Reporting

·         Ensure adherence to HIPAA and regulatory requirements

·         Support internal and external audits

·         Generate billing and credentialing reports for leadership

·         Identify trends in denials and recommend process improvements

Education & Experience:

·         High school diploma or GED equivalent

·         3+ years of experience in medical billing, coding, and credentialing

Preferred Qualifications

·         Associate’s or Bachelor’s degree

·         Experience in behavioral health, mental health, or substance abuse setting

·         CPC (Certified Professional Coder), CCS, or equivalent