Billing and Credentialing Specialist with Emphasis on Behavioral Health

The Billing and Credentialing Specialist manages client information in billing software, submits insurance claims, and supports employees by coordinating credentialing and re-credentialing processes.

Required qualifications include an associate degree or three years related experience, Medical Billing and Coding Certification or equivalent, and at least two years experience in behavioral health billing, coding, and credentialing. Candidates should have strong communication and organizational skills, proficiency in Microsoft Office, ability to work independently and in teams, high confidentiality standards, and a valid New Mexico driver's license with local travel willingness.

Responsibilities include credentialing new hires and billable staff per payer requirements, maintaining provider files, assisting with license applications and renewals, completing revalidations and re-credentialing applications, resolving credentialing denials or authorization issues, and maintaining accurate provider profiles. On the billing side, preparing, reviewing, and transmitting claims electronically and on paper, billing MCOs within 30 days of employment, ensuring staff have NPI and Medicaid numbers, explaining insurance processes, following up on unpaid claims, appealing denied claims, verifying payments, updating billing software, and ensuring compliance and confidentiality.

Other duties include attending staff meetings and supporting the organizational mission.

Physical demands involve extensive phone and computer use, occasional lifting up to 25 pounds, climbing stairs, and mostly desk-based work.

Work location is hybrid remote in Albuquerque, NM.