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Medical Billing and Credentialing Specialist

ClaimDOC

Mar 2024 - Mar 2025 • 1 yr

Medical Billing and Credentialing Specialist | 1 Year Experience Worked as a Medical Billing and Credentialing Specialist for one year, managing billing operations and provider credentialing processes for healthcare practices. Responsible for submitting and following up on insurance claims, verifying patient insurance eligibility and benefits, resolving claim denials, and ensuring accurate reimbursement from insurance carriers. Handled provider credentialing and re-credentialing with commercial insurance companies, maintaining provider records and ensuring compliance with payer requirements. Coordinated with healthcare providers, insurance representatives, and internal teams to expedite enrollment and credentialing approvals. Key responsibilities included: * Insurance verification and benefits checking * Medical claim submission and payment posting * Denial management and accounts receivable follow-up * Provider enrollment, credentialing, and re-credentialing * Maintaining provider documentation and compliance records * Communicating with insurance payers regarding claim and credentialing issues * Ensuring accuracy and confidentiality of patient and provider information Achievements: * Recognized as a Monthly Reward Holder on three occasions for outstanding performance, accuracy, and productivity. * Consistently met billing and credentialing targets while maintaining high-quality standards. * Contributed to reducing claim processing delays and improving provider enrollment efficiency. * Demonstrated strong attention to detail, problem-solving abilities, and effective communication skills in a fast-paced healthcare environment. Developed expertise in medical billing procedures, insurance regulations, provider credentialing processes, and healthcare administration while maintaining a commitment to excellent service and operational efficiency.