Credentialing Specialist

Position Summary

New Era Billing Services is seeking a detail-oriented Medical Billing / Credentialing Specialist to support billing, claims, provider credentialing, documentation, and compliance activities. This role is responsible for reviewing medical billing information, supporting claim submission and follow-up, maintaining credentialing files, verifying documentation, and ensuring accurate records in accordance with company, client, payer, and regulatory requirements.

The ideal candidate has experience in medical billing, claims processing, insurance verification, credentialing, healthcare administration, or revenue cycle support.

Duties and Responsibilities

As a Medical Billing / Credentialing Specialist, you will:

• Review patient, provider, billing, and insurance information for accuracy and completeness.
• Prepare, submit, and track medical claims to insurance carriers, government payers, or third-party administrators.
• Follow up on unpaid, denied, rejected, or underpaid claims.
• Review Explanation of Benefits (EOBs), remittance advice, and payer correspondence.
• Identify billing errors, coding issues, missing documentation, or authorization problems.
• Assist with insurance verification, eligibility checks, prior authorization tracking, and claim status inquiries.
• Post payments, adjustments, and denials as required.
• Support provider credentialing and recredentialing activities, including collection and verification of licenses, certifications, insurance, training records, and payer enrollment documentation.
• Maintain accurate billing, credentialing, and compliance records in electronic systems, spreadsheets, or databases.
• Communicate with providers, payers, employees, vendors, and internal departments to resolve billing or credentialing issues.
• Track credential expiration dates, payer enrollment status, and required documentation.
• Support audits by preparing billing records, credentialing files, reports, and compliance documentation.
• Maintain confidentiality of patient, provider, employee, and company information in accordance with HIPAA and company policies.
• Perform other billing, credentialing, or administrative duties as assigned.

Requirements

Conditions of Employment

• Must be authorized to work in the United States.
• Must be able to pass a background check and drug screening, if required.
• Must be able to handle confidential patient, provider, employee, and company information.
• Must comply with HIPAA, privacy, and data security requirements.
• Must be able to meet deadlines in a fast-paced administrative environment.

Qualifications

To qualify for this position, candidates should have:

• Minimum of 2 years of experience in medical billing, claims processing, revenue cycle, provider credentialing, healthcare administration, or a related role.
• Knowledge of medical billing processes, claim submission, denial follow-up, and payer requirements.
• Familiarity with insurance verification, EOBs, remittance advice, prior authorizations, and claim status follow-up.
• Strong attention to detail and ability to review documentation for accuracy and completeness.
• Strong written and verbal communication skills.
• Ability to manage multiple files, deadlines, payers, and follow-up tasks at once.
• Proficiency with Microsoft Office, including Outlook, Word, and Excel.
• Ability to learn and use billing systems, credentialing platforms, payer portals, databases, and document management tools.
• Professional judgment and discretion when handling confidential information.

Preferred Qualifications

• Experience with Medicare, Medicaid, TRICARE, commercial insurance, or workers’ compensation billing.
• Experience with provider enrollment, payer credentialing, CAQH, NPI, or license verification.
• Familiarity with CPT, ICD-10, HCPCS, modifiers, and basic coding concepts.
• Experience resolving denied or rejected claims.
• Knowledge of HIPAA and healthcare compliance requirements.
• Certification such as CPC, CPB, CMRS, RHIT, or related healthcare billing/credentialing certification.
• Experience supporting federal healthcare contracts or government contractor environments.

Education

• High school diploma or GED required.
• Associate degree or higher in Healthcare Administration, Medical Billing and Coding, Business Administration, or a related field preferred.
• Formal training in medical billing, coding, healthcare administration, or credentialing preferred.

Work Environment

This position is primarily administrative and may be performed in an office work environment depending on company and contract needs. The role requires regular computer use, phone and email communication, payer portal access, document review, data entry, and coordination with internal and external stakeholders.

Benefits

• Competitive salary commensurate with experience
• Medical, dental, and vision insurance
• 401(k) with company match after 1 full year, vested
• Paid Time Off (PTO)
• Paid Holidays
• Professional development and training assistance

Equal Opportunity Employer

New Era Billing Services an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status, or any other characteristic protected by applicable law