Credentialing and Claims Specialist

Job Title: Credentialing and Claims Specialist

Position type: Full-Time

Work hours: 9:00 AM to 5:00 PM Eastern Daylight Time

Work days: Monday to Friday

Salary: $6 - $7 per hour, depending on experience

Workplace: Remote

Preferred Candidate Location: Philippines

Our client is seeking an experienced, highly organized, and solutions-driven Credentialing & Claims Specialist to support insurance credentialing, rejected claims resolution, billing coordination, and insurance verification for a growing behavioral health practice.

This role is critical to helping the practice resolve urgent credentialing and insurance rejection issues currently affecting reimbursement timelines and operational efficiency. The ideal candidate will have strong experience managing insurance claims, credentialing workflows, denials, and payer communication while maintaining accuracy and organization across multiple follow-up tasks.

As the Credentialing & Claims Specialist, you will primarily focus on resolving rejected claims, correcting credentialing issues with insurance companies, and managing insurance verification and copay workflows. You will also support prior authorizations, patient transfers between systems, scheduling coordination, and claim tracking within the EMR.

The client is looking for someone who can work independently, communicate professionally with insurance companies, and take ownership of resolving issues quickly and efficiently. Strong attention to detail, persistence, and the ability to manage urgent follow-ups are essential for success in this role.

This is an excellent opportunity for someone with strong medical billing and credentialing experience who enjoys problem-solving, improving operational workflows, and helping healthcare practices maintain healthy reimbursement processes.

Scope of Work / Responsibilities

Claims Management & Resolution

• Manage rejected claims follow-up and resolution
• Track claim submissions and monitor for denials or rejections
• Investigate claim issues and coordinate corrective actions
• Communicate directly with insurance companies regarding billing and reimbursement concerns

Credentialing & Insurance Coordination

• Handle insurance credentialing fixes and provider enrollment issues
• Ensure provider credentialing remains updated and active within insurance systems and Tebra Care
• Process insurance verification and eligibility checks
• Support copay collection and insurance coordination workflows

Administrative & Operational Support

• Manage prior authorization workflows
• Transfer patient information from Zocdoc into Tebra EMR
• Assist with schedule management and calendar optimization
• Maintain organized follow-up systems and documentation tracking
• Collaborate closely with internal staff to support operational efficiency

Top 3 Priorities

1. Rejected Claims Follow-Up & Resolution

Quickly investigate and resolve denied or rejected claims to minimize reimbursement delays and revenue disruption.

2. Insurance Credentialing & Corrections

Identify and resolve credentialing issues with insurance companies while ensuring accurate provider enrollment status.

3. Insurance Verification & Copay Coordination

Maintain accurate insurance verification processes and support efficient copay collection workflows.

Key Performance Indicator (KPI)

Success in this role will primarily be measured by:

• Speed and effectiveness in resolving credentialing and claims issues
• Reduction in unresolved claim denials and rejections
• Timely insurance verification and payer follow-up
• Improved billing workflow efficiency and reimbursement turnaround time

Requirements:
Required Skills and Experience

• Strong experience with medical billing, claims processing, and insurance workflows
• Expertise handling claim denials, rejected claims, and underpayments
• Prior credentialing experience is REQUIRED
• Experience communicating directly with insurance companies regarding claims and credentialing issues
• Strong attention to detail and organizational ability
• Ability to independently manage multiple follow-ups and deadlines
• Professional written and verbal communication skills
• Collaborative mindset and ability to work effectively with internal staff

Required Systems & Tools Experience

Must-Have Experience

• Tebra Care (required)
• Familiarity with multiple EHR/EMR systems
• Experience working with insurance portals and billing systems

Technical Setup

• Tebra EMR access
• Google Voice phone system integration

Preferred Experience

• Background in behavioral health or mental health practices
• Experience with prior authorizations and insurance verification workflows
• Familiarity with patient scheduling and administrative coordination

Ideal Candidate Profile

The ideal candidate is:

• Highly organized and detail-oriented
• Persistent and proactive when resolving insurance issues
• Solutions-focused and comfortable handling urgent workflows
• Able to work independently with minimal supervision
• Reliable, accountable, and process-driven
• Professional and confident when communicating with insurance representatives

Basic requirements

• Must be proficient in speaking and writing English very clearly
• Must have relevant work experience
• Be able to submit an NBI clearance and/or Local Police Clearance background check before onboarding [mandatory]
• Must be available for video meetings with your camera on (when needed)

Technical requirements

• Device: Reliable laptop or desktop computer.
• Internet: High-speed connection (minimum 10 Mbps).
• Audio: Noise-canceling headset.
• Video: Webcam for virtual meetings.
• Workspace: Quiet, professional environment.

Benefits:
• Dedicated HR & Contractor Support Team: Access to world-class support for questions, guidance, contract matters, and client communication.
• Premium VPN Access (Optional): A secure VPN license can be provided upon request to enhance privacy and security for client-related tasks.
• HIPAA & Cybersecurity Training + Certification (Provided): Access to our internal HIPAA compliance training, cybersecurity modules, and certification to help you confidently handle PHI for U.S. healthcare clients.
• Top 1% VA Performance Training: Access to our proprietary training on communication, client management, productivity systems, and best practices to help you become a top-performing VA and increase long-term client retention.
• Client-Approved U.S. Holidays: Contractors may take U.S. holidays off according to the client’s needs and schedule.
• Client-Approved Paid or Unpaid Time Off: Time off may be granted by your client. Paid time off is optional and only if offered by the client.
• Access to Tools & Resources: Templates, workflow guides, productivity tools, and client-specific SOP support to help you perform at your best.
• Optional Performance-Based Incentives: Some clients may offer bonuses, incentives, or increased hours based on your performance.

These are optional resources and client-approved allowances available to you as an independent contractor. Any resources, trainings, or allowances listed are optional contractor perks and not employee benefits.