Credentialing Specialist (Hiring Immediately)

Credentialing & Revenue Cycle Specialist (Onsite)

Schedule: Monday – Friday, 9:00 AM – 5:00 PM (1-hour unpaid lunch, 35-hour work week)

We are seeking a detail-oriented and proactive Credentialing & Revenue Cycle Specialist to join our team. This is an onsite position focused primarily on managing provider credentialing and secondarily supporting AR-related functions when credentialing volume is low. The ideal candidate will serve as a key liaison between our providers and external credentialing agency, while also performing follow-up on surgical and E&M claims, appeals, and other tasks within the revenue cycle department.

Key Responsibilities

Credentialing Duties:

• Act as the main point of contact between providers, the practice, and the credentialing company.
• Gather and maintain up-to-date provider documents, including licensing, DEA, CPR certifications, malpractice insurance, NPIs, and hospital privileges.
• Proactively respond to document requests from the credentialing company with minimal supervision.
• Identify discrepancies or process issues and address them collaboratively.
• Maintain organized provider files and credentialing databases; track credentialing status using spreadsheets and internal systems.
• Submit documentation to payers, hospitals, and the credentialing agency as needed.
• Ensure all credentialing requirements are complete and up-to-date, including special projects as assigned.

Accounts Receivable / Revenue Cycle Support:

• Perform follow-up on out-of-network surgical and E&M claims.
• Address denials, submit appeals, and resolve billing discrepancies through reprocessing, corrections, or reconsiderations.
• Analyze EOBs, underpayments, contractual adjustments, and patient balances.
• Communicate with payers via phone and online portals to check claim statuses and resolve outstanding issues.
• Respond to patient or payer inquiries via phone, email, and other channels in a timely and professional manner.
• Assist with refunds, payment applications, and general billing support as needed.

Ideal Candidate Profile

• Highly organized with excellent attention to detail.
• Strong communicator who can address credentialing issues without creating conflict.
• Comfortable managing multiple responsibilities across credentialing and billing.
• Able to work independently and take initiative in solving problems.
• Willing to take on new tasks and learn AR workflows as needed.

Required Qualifications

• 2+ years of medical credentialing experience (hospital or private practice).
• Understanding of the credentialing process and how it impacts the revenue cycle.
• Experience with surgical claims (ENT, orthopedics, bariatrics, neurosurgery, plastic & reconstructive surgery preferred).
• Familiarity with EOBs, CPT/ICD-10 coding, denial reasons, and appeals processes.
• Strong computer skills: Excel, SharePoint, PDF tools, Outlook, and OneDrive.
• Excellent written and verbal communication skills.
• High level of professionalism and customer service.
• Notary Public or willingness to become one.

Preferred Experience

• Dual experience in both credentialing and AR.
• Experience with out-of-network billing and surgical claim follow-up.
• Prior use of EMR systems such as Centricity or ModMed.

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.

Our commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers! The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?