On-Site / Hybrid / Remote
About Achievement Behavior Services (ABS):
Achievement Behavior Services (ABS) is a growing ABA therapy agency serving children with autism and developmental delays. Our team is dedicated to delivering high-quality, personalized care that enables children and families to thrive. We are seeking a Medical Credentialing & Billing Coordinator to join our administrative team and support our credentialing, billing, and insurance operations.
Position Summary:
The Medical Credentialing & Billing Coordinator plays a crucial role in ensuring that our providers are properly credentialed, insurance claims are processed accurately, and patients and their families have a seamless billing experience. This role collaborates closely with insurance payers, third-party billing partners, clinical staff, and families to ensure seamless operations and effective revenue cycle management.
Key Responsibilities:
Credentialing & Enrollment:
- Manage full-cycle credentialing and re-credentialing for providers with Medicaid, commercial insurance, and managed care organizations.
- Submit applications via CAQH, NPPES, and payer portals; monitor status and resolve delays.
- Maintain credentialing files, track re-credentialing deadlines, and ensure continuous enrollment.
- Stay up-to-date with insurance policies and credentialing requirements.
Billing & Insurance Support:
- Act as a primary contact for patient billing questions, insurance coverage explanations, and payment plans.
- Review and resolve claim denials and rejections by working with our third-party billing company.
- Identify and correct credentialing errors, authorization issues, or missing documentation impacting claims.
- Submit appeals and claim resubmissions as needed.
- Review Explanation of Benefits (EOBs) for payment accuracy.
Revenue Cycle Coordination:
- Partner with the billing company to monitor claim trends, underpayments, and processing delays.
- Maintain accurate payment records and documentation for patient accounts.
- Support regular revenue reporting and claim reconciliation processes.
Qualifications:
- 2–5 years of experience in medical billing, credentialing, or revenue cycle management (RCM).
- Experience with ABA, pediatric healthcare, behavioral health, or mental health strongly preferred.
- Knowledge of insurance billing terminology: CAQH, NPPES, EOBs, deductibles, co-pays, Medicaid, commercial payers.
- Proficiency with EMR/billing systems (Rethink EMR preferred).
- Strong communication, organizational, and problem-solving skills.
- Ability to explain billing and insurance concepts to patients and families clearly and compassionately.
- HIPAA compliant and committed to confidentiality.
- Associate’s degree required; Bachelor’s degree preferred.
What We Offer:
- Competitive salary based on experience
- Medical insurance & paid time off (PTO)
- Flexible work options: On-site / Hybrid / Remote
- Supportive and collaborative team environment
- Opportunity to make a meaningful difference for children and families
