Medical Biller / Coder & Credentialing Specialist

Position Overview

The Medical Biller / Coder & Credentialing Specialist will manage key functions of the revenue cycle including coding accuracy, claims processing, payer credentialing, denial management, and provider enrollment. This role works closely with providers, leadership, and clinical teams to ensure accurate billing, compliance with payer requirements, and efficient reimbursement processes.

Key Responsibilities

• Medical Coding

  • Review provider documentation and assign accurate ICD-10, CPT, and HCPCS codes
  • Ensure coding complies with payer regulations and industry guidelines
  • Identify documentation gaps and communicate with providers when clarification is required

• Clinical Support

  • Support coding compliance and documentation improvement
  • Prepare and submit electronic claims through the practice management system
  • Maintain provider enrollment records and credentialing documentation
  • Coordinate payer enrollment applications and updates

• Revenue Cycle Management

  • Monitor and manage accounts receivable
  • Track aging reports and follow up on outstanding balances
  • Investigate underpayments and payer discrepancies
  • Support efforts to improve clean claim rate and reduce days in A/R

• Provider Credentialing & Enrollment

  • Manage provider credentialing and recredentialing with commercial and government payers
  • Maintain provider enrollment records and credentialing documentation
  • Track credentialing timelines and renewal deadlines
  • Coordinate payer enrollment applications and updates

• Compliance & Quality

  • Maintain compliance with billing regulations and payer policies
  • Support internal billing and coding audits
  • Ensure HIPAA compliance and protection of patient data

• Reporting & Operational Support

  • Generate billing, collections, and credentialing status reports
  • Identify opportunities to improve billing workflows and revenue cycle performance
  • Collaborate with leadership to improve operational efficiency

Qualifications

• Minimum 3 years experience in medical billing, coding, or revenue cycle management

• Experience with provider credentialing and payer enrollment

• Strong knowledge of ICD-10, CPT, and HCPCS coding

• Experience working with insurance payers and claim follow-up

• Strong attention to detail and organizational skills

Preferred

• CPC, CCS, Or Equivalent Coding Certification

• Experience in dermatology or outpatient specialty practices

• Experience with Modernizing Medicine (ModMed EMA) or similar EMR systems

• Knowledge of dermatology procedures, Mohs surgery billing, or cosmetic services

What We Offer

• Competitive compensation based on experience

• Monday–Friday work schedule

• Professional and collaborative work environment

• Opportunity to support and improve revenue cycle operations within a growing healthcare organization

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