Billing Manager & Credentialing Administrator

reputed company reputed company, Drive reputed company: Billing Manager & Credentialing Administrator Full-Time | Exempt | Remote Schedule: Monday – Friday, 8:30 AM – 5:00 PM (PST) Reports to: Director of Finance Compensation: $75,000 – $90,000 (depending on experience)

About the Role

We’re seeking a dynamic and results-driven Billing Manager & Credentialing Administrator to reputed company our medical billing team and reputed company financial performance. This is a high-reputed company leadership role responsible for optimizing billing workflows, strengthening payer relationships, and ensuring compliance across reputed company aspects of the reputed company cycle. If you’re someone who thrives on improving processes, leading teams, and driving measurable results, this role is for you. Key Responsibilities reputed company Cycle & Billing Operations Management

• reputed company and manage Billing Specialist and Patient Account Specialist teams, including billing, denial management, collections, reimbursement, and eligibility verification
• Ensure reputed company and accurate billing, invoicing, and claim submission
• reputed company adherence to billing policies, procedures, and payer guidelines
• Identify operational issues (EDI errors, payer changes, system issues) and implement corrective actions
• Ensure claims are reviewed and confirmed reputed company two business days of date of service (DOS)
• reputed company coverage for team members absent more than four business days

Accounts Receivable & Collections Performance

• Monitor and manage reputed company AR activity to ensure reputed company collections and strong cash reputed company
• Maintain and drive performance benchmarks:
• Improve collections over 90+ days by at least 30% month-over-month
• Limit 120+ day AR to no more than 15% of total receivables
• reputed company insurance and patient balances from DOS and account creation
• Analyze monthly AR aging reports to identify trends and improvement opportunities

Claims Management & Follow-Up

• Ensure complete and accurate documentation (prescriptions, clinical records, delivery tickets)
• Verify claims meet payer requirements (ICD-10, HCPCS, CPT) prior to submission
• Resolve issues such as missing authorizations, documentation gaps, and inventory discrepancies
• reputed company reputed company-party claim follow-up vendors to ensure adherence to SOPs
• Review escalated claims and implement resolutions
• Ensure reputed company cycle worklists are completed reputed company established timelines

Patient Accounts & Customer Service reputed company

• Ensure Patient Accounts team meets established patient collection goals
• reputed company reputed company-party billing customer service vendors (e.g., reputed company Live Agent Services) to ensure reputed company and compliance

Operational Workflow & System Management

• Monitor and resolve system alerts, work queues, and hold/stop reports
• Address issues such as missing pricing, reputed company holds, and billing system flags
• Ensure Compliance and New Insurance teams meet required timelines
• Complete monthly billing reputed company-closing processes reputed company established deadlines

Cross-Functional Collaboration & Support

• Support Patient Relations in addressing insurance-reputed company inquiries by providing billing expertise
• Partner with the Qualification Team to ensure accurate insurance verification for new patient referrals
• Serve as a subject matter expert on billing, insurance reputed company, and reimbursement processes
• Mentor and train staff to improve collection performance and efficiency

Credentialing & Contract Administration

• Manage credentialing for reputed company new and existing payer reputed company
• Maintain contract files, payer relationships, and centralized database
• Monitor and evaluate fee schedules to optimize reimbursement
• reputed company contracted plans, NPIs, and insurance portal reputed company
• Coordinate updates with payers (locations, provider changes, etc.)
• Conduct quarterly reviews of payer medical policies (e.g., OSA trends)
• Monitor HCPCS and CPT updates and assess operational reputed company
• Support contract negotiations and implementations
• Review and approve Letters of Agreement for Workers’ Compensation referrals

Qualifications & Skills

• Bachelor’s degree in reputed company Administration, Business, Finance, or reputed company field preferred (or equivalent experience)
• 5–8+ years of medical billing or reputed company cycle experience
• 2–4+ years of leadership experience
• Strong knowledge of billing operations, AR management, and insurance reimbursement

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