Community Care of North Carolina Inc

Compensation

Full Description

Position Summary The Billing and Credentialing Lead is a vital member of the administrative team, responsible for supporting the financial and operational functions of the medical group through accurate medical billing and thorough provider credentialing. This dual-role position ensures that providers are properly credentialed with all applicable payers and that claims are submitted and reimbursed correctly and efficiently. This individual serves as the primary liaison between the practice, insurance companies, and credentialing entities, ensuring compliance with regulatory standards while maximizing revenue cycle performance. The ideal candidate will possess a strong understanding of healthcare billing practices, insurance payer guidelines, and the credentialing process, and will have the organizational skills to manage multiple timelines and priorities with precision. The role requires meticulous attention to detail, the ability to navigate complex payer systems, and strong communication skills to resolve claim issues and credentialing delays. This position is instrumental in maintaining the practice’s financial health, reducing claim denials, and ensuring timely enrollment and re-credentialing of healthcare providers. • *Essential Functions • Own and manage key billing and credentialing processes, ensuring accuracy, compliance, and efficiency • Assist leadership in Monitoring aging reports to ensure timely collection and resolution. • Respond to billing inquiries from patients, staff, and insurance carriers in a professional and timely manner • Follow up on unpaid, denied, or rejected claims, including researching denial reasons, correcting claims, and submitting appeals as needed • Review and verify accuracy of billing data and ensure compliance with payer rules, coding standards, and regulatory requirements • Complete and manage provider credentialing and re-credentialing applications for insurance payers • Ensure payments and adjustments from insurance carriers and patients are posted and reconciled into the practice management system timely and accurately • Track credentialing timelines to ensure timely submission, renewal, and follow-up to prevent lapses in enrollment or billing eligibility • Maintain provider profiles in CAQH, PECOS, NPPES, and payer portals, ensuring accuracy and current documentation • Ensure all required documentation (licenses, DEA, malpractice, board certifications, etc.) is collected, verified, and filed • Communicate with insurance carriers and credentialing contacts to follow up on application status and resolve delays • Monitor and notify management of upcoming expirations for licenses, certifications, and other credentialing-related documentation • Collaborate with practice managers, providers, and administrative staff to resolve billing or credentialing issues • Oversee and provide direction to team members involved in related tasks • Qualifications* • High school diploma or GED required • Bachelor's degree preferred, or a minimum of 4-7 years of experience in a healthcare setting in lieu of a degree • Experience with provider enrollment and credentialing with Medicare, Medicaid, and private insurance carriers • Maintain a valid driver’s license with current auto liability insurance Knowledge, Skills, and Abilities • Proficiency in electronic medical record (EMR) and practice management systems (e.g., Athenahealth, eClinicalWorks, TriMed, etc.) • Computer skills required including various office software and the internet; experience with MS Office software preferred • Familiarity with maintaining and updating CAQH, PECOS, and NPPES profiles • Strong understanding of medical billing procedures and coding systems (ICD-10, CPT, HCPCS) • Competency in using online payer portals and credentialing databases • Excellent communication skills – oral and written • Organizational and time management skills • Knowledge of medical terminology • Responds to change with a positive attitude and a willingness to learn new ways to accomplish work activities and objectives • Able to shift strategy or approach in response to the demands of a situation • * Working Conditions • The job environment is primarily a home environment • Multiple contacts may be required with various members, providers, multi-payer systems and community partners to ensure coordination of services; exposure to general office, community, and household conditions, as well as communicable disease could occur • Routinely there may be some minor physical inconveniences or discomforts in the work setting, including sitting for moderate periods of time • Must be able to utilize office equipment, computer, keyboard, and phone with or without assistive devices • Repetitive wrist motion and occasional lifting/carrying of up to 25 pounds • The job environment can be intense as high volume; repetitive work is an expectation • Travel may be required within the region and/or the State Work Location: Remote