Billing/Credentialing Specialist

This is a remote position.

Our client is looking for a Billing/Credentialing Specialist to support medical billing operations, provider enrollment, credentialing, and payer-related processes within a growing virtual healthcare organization. They operate in the telehealth and remote care industry and have recently expanded technology-enabled programs that have produced measurable improvements in patient monitoring, care coordination, and hospital readmission outcomes.

The ideal candidate has hands-on experience with U.S. healthcare billing and provider credentialing, understands how to navigate insurance and government payer requirements, and can maintain accurate documentation across multiple systems. Experience using Athenahealth EMR is strongly preferred.
Responsibilities
- Manage medical billing activities, including claim creation, review, submission, and follow-up.

- Verify that claims contain accurate patient, provider, insurance, coding, and service information before submission.

- Monitor rejected and denied claims, identify the reason for nonpayment, and coordinate timely corrections or appeals.

- Follow up on outstanding accounts receivable and unresolved claims with insurance carriers.

- Post insurance and patient payments accurately within the billing or electronic medical record system.

- Review explanation of benefits and electronic remittance information to identify adjustments, underpayments, and denials.

- Confirm patient eligibility, insurance coverage, and authorization requirements when needed.

- Maintain accurate billing documentation and update account notes after each follow-up action.

- Coordinate the complete provider credentialing and recredentialing process.

- Prepare, submit, and monitor provider enrollment applications with Medicare, Medicaid, and commercial insurance plans.

- Maintain accurate provider information in credentialing databases and payer portals.

- Update and manage provider profiles through platforms such as CAQH, PECOS, and NPPES.

- Gather licenses, certifications, education records, insurance documentation, work history, and other supporting materials required for credentialing.

- Track application deadlines, expirations, renewals, and outstanding payer requests.

- Follow up with insurance carriers and credentialing organizations regarding application status and missing information.

- Maintain organized and audit-ready credentialing records.

- Communicate clearly with providers, internal team members, insurance representatives, and external partners.

- Protect patient and provider information in accordance with HIPAA and organizational privacy standards.

Requirements

- Proven experience in medical billing, provider credentialing, provider enrollment, or a closely related U.S. healthcare function.

- Working knowledge of the U.S. healthcare reimbursement process.

- Experience submitting and following up on claims with Medicare, Medicaid, and commercial insurance carriers.

- Understanding of claim denials, payment posting, accounts receivable follow-up, and insurance verification.

- Familiarity with provider enrollment, credentialing, and recredentialing processes.

- Ability to manage confidential patient and provider information in accordance with HIPAA requirements.

- Strong attention to detail and the ability to identify incomplete, inconsistent, or inaccurate information.

- Excellent organizational and documentation skills.

- Ability to manage multiple applications, deadlines, and follow-up activities simultaneously.

- Strong written and verbal English communication skills.

- Ability to work independently in a remote environment while maintaining consistent communication and accountability.

- Reliable internet connection and a professional remote workspace.

Qualifications
- Previous experience using the Athenahealth, AthenaOne EMR platform is required.

- Experience with CAQH, PECOS, NPPES, Medicare enrollment systems, and commercial payer por