Billing and Credentialing Specialist

The Billing Specialist (Billing & Credentialing) is responsible for accurate and timely submission of claims, posting payments, resolving patient billing inquiries, provider credentialing and enrollment activities, and overall revenue cycle support. Ensures compliance with payer guidelines, FQHC billing regulations, Sliding Fee Scale (SFS) documentation, and Good Faith Estimate (GFE) requirements under the No Surprises Act. Supports revenue integrity by maintaining active provider enrollments and accurate payer files.

Responsibilities include submitting clean and accurate claims to commercial, Medicare, Medicaid, and other payers via electronic and paper methods; posting payments and reconciling discrepancies; generating and distributing patient statements; resolving billing inquiries; assisting patients with billing concerns, payment plans, and financial assistance including SFS applications; ensuring GFE compliance by preparing and providing Good Faith Estimates to uninsured and self-pay patients; monitoring accounts receivable and submitting corrected or appealed claims; maintaining HIPAA and federal/state billing regulation compliance; documenting and escalating collection activities; participating in meetings, training, and quality improvement; and staying current with FQHC billing practices, payer guidelines, and coding updates.

Must promote healthcare integration and Patient-Centered Medical Home principles.

Qualifications include working knowledge of medical billing practices including ICD-10 and CPT coding, familiarity with commercial, Medicaid, Medicare billing, proficiency with EMR and billing software, strong organizational skills, excellent communication and customer service skills, ability to follow instructions and manage multiple priorities, professional telephone etiquette, and ability to maintain confidentiality.

Education requires a high school diploma or equivalent; Medical Billing and Coding certification preferred; technical or vocational training in medical billing a plus.

Experience requires minimum one year in medical billing and credentialing/enrollment preferred, with equivalent practicum experience considered.

Work environment is office-based clinical/business within healthcare, involving interaction with patients, providers, payers, and staff by phone, email, and in person, with a fast-paced setting tied to billing and credentialing deadlines.