Billing & Credentialing Specialist

Pay equivalent: $50,000–$60,000/annually (experience and credential dependent)

Location: 8790 W. Colfax Ave, Lakewood
Employment Type: Part-time with potential to become full-time

About the role

Denver Recovery Group (DRG) is seeking an experienced Billing & Credentialing Specialist to join our growing team. This position is responsible for managing provider credentialing and enrollment, with a strong emphasis on Colorado Medicaid (HCPF) requirements.

Responsibilities

• Colorado Medicaid Enrollment
  • Complete and manage provider enrollments, revalidations, updates, and affiliations through the Colorado interChange Provider Portal.
  • Monitor application status and resolve enrollment issues promptly.
  • Maintain accurate provider records and ensure timely renewals.
• Provider Credentialing
  • Perform primary source verification of provider credentials, including:
    • State licensure
    • DEA registrations
    • Board certifications
    • Education and training
    • Professional references
  • Maintain credentialing files and ensure compliance with regulatory and payer requirements.
  • Coordinate credentialing and recredentialing with commercial insurance carriers as needed.
• Compliance & Reporting
  • Maintain compliance with Colorado Department of Health Care Policy and Financing (HCPF), CMS, HIPAA, and payer requirements.
  • Stay informed of changes in Medicaid billing, credentialing, and reimbursement policies.
  • Prepare reports related to credentialing status, enrollment activity, and billing performance.

Requirements

• Associate’s degree in Healthcare Administration, Business Administration, Medical Billing, or a related field, or equivalent work experience.
• 2–4 years of experience in provider enrollment or payer credentialing.
• Demonstrated experience working with Colorado Medicaid (HCPF) provider enrollment and billing.
• Strong understanding of:
  • Colorado HCPF policies and procedures
  • RAE Requirements and Contracting
  • Third Party Insurance
  • CAQH provider data management
  • CMS regulations
  • CPT, ICD-10, and HCPCS coding standards
• Experience working with Electronic Health Record (EHR) and practice management systems.
• Excellent organizational, analytical, and problem-solving skills.
• Strong written and verbal communication skills.
• Ability to manage multiple priorities while meeting deadlines with a high degree of accuracy.

Preferred Qualifications

• Certified Provider Credentialing Specialist (CPCS)