Medical Billing & Insurance Credentialing Specialist

About the role

We're bringing insurance billing in-house and need a skilled billing and credentialing specialist to own it. You'll work inside Healthie (HER) and ClaimMD (EDI) — modern tools that handle a lot of the heavy lifting — but this role still requires a sharp, experienced person who knows how to read a denial, fix a claim, credential a provider, and talk to a client about their benefits without making their eyes glaze over.

What You'll Own

• Submitting claims from Healthie to ClaimMD and staying on top of what comes back
• Resolving denied or rejected claims — ClaimMD surfaces the reason codes, you take it from there (corrections, resubmissions, or formal appeals)
• Eligibility verification before appointments — ClaimMD covers most payers; you'll handle the rest through payer portals
• Invoicing clients for copays and coinsurance once the insurance payment is received
• Managing accounts receivable and following up on aging balances
• Tracking referral requirements and coordinating with clients and referring providers when needed
• Handling prior authorizations for the occasional plan that requires it (not common for MNT, but it does come up with some Medicaid and HMO plans)
• Credentialing new providers and keeping everything current — CAQH profiles, revalidations, payer enrollments, expiring documents
• Being the person the front desk staff, clients and providers turn to when they have an insurance question — and actually helping them understand the answer

What We're Looking For

• 4+ years of medical billing experience (nutrition or wellness setting is a bonus)
• ClaimMD or equivalent clearinghouse experience
• Solid CPT/ICD-10 coding knowledge, especially MNT codes (97802, 97803, 97804)
• Credentialing experience — CAQH, payer enrollment, the whole process
• Comfortable with payer portals (Availity, NaviNet, etc.)
• A communicator who can explain insurance in plain English
• Someone who runs their own work, hits their own deadlines, and doesn't need to be managed

What You'll Get

• A team that actually respects your personal time
• Recognition for the work you do — in a small practice, good work doesn't go unnoticed
• Room to make this role your own and improve how things run
• Competitive pay based on your experience
• Health Insurance, Paid Time Off, 401K, Life Insurance, Employee Discount

Flexible work from home options available.