Medical Billing & Credentialing Specialist

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CommonHealth Recovery is seeking a self-driven, detail-oriented Billing, Coding & Credentialing Specialist to manage and oversee all billing operations for the practice. This position serves as the backbone of our revenue cycle, responsible for building structure within the billing department, delivering actionable financial insights to leadership, and driving operational efficiency. The right candidate is accountable to their processes, takes ownership of outcomes, and brings innovation to the role.

COMPANY OVERVIEW: CommonHealth Recovery is a leading provider of drug and alcohol treatment services in Frankfort and surrounding KY cities, serving Medicaid, Medicare, and Commercial populations. As a licensed AODE and DUI treatment facility, we offer outpatient counseling, intensive outpatient programming, medication-assisted treatment, and case management services through an evidence-based, harm reduction-focused approach.

BILLING & REVENUE CYCLE:

• Submit claims to third-party payors accurately using billing programs.
• Call and status outstanding claims with third-party payors.
• Review and resolve claim issues, denials, and underpayments; rebill as needed.
• Review explanation of benefits to ensure claims are processed and paid correctly.
• Post payments to the billing system and ensure proper medical billing accounting on each account.
• Complete adjustment forms with supporting documentation when corrections are needed.
• Maintain accounts receivable within acceptable payment timeline ratios.
• Prorate patient accounts and monitor balances within the correct financial class.
• Work with patients to explain insurance benefits and financial obligations.
• Alert CEO of all benefit eligibility matters that may challenge reimbursement.

REPORTING & FINANCIAL ANALYSIS:

• Create and present monthly billing reports directly to the CEO.
• Build reports using Excel, pivot tables, and billing system tools that pinpoint cashflow issues, denial trends, aging AR, and revenue gaps.
• Manage daily productivity via patient accounting system and productivity reports.
• Complete revenue projections and identify billing trends during monthly AR meetings.
• Gather and interpret data from systems to determine appropriate courses of action, initiating time-sensitive steps that result in fast and efficient payment.

EHR MANAGEMENT:

• Serve as the in-house EHR subject matter expert.
• Set up, configure, and optimize EHR system settings to support billing and clinical workflows.
• Build and maintain templates within the EHR.
• Demonstrate a deep understanding of EHR functionality and best practices.

CREDENTIALING & COMPLIANCE:

• Credential and enroll new providers with established insurance payors.
• Maintain insurance payor quality control regarding medical billing standards and guidelines.
• Conduct periodic billing audits and train providers on documentation improvements for enhanced reimbursement.

AI & PROCESS IMPROVEMENT:

• Leverage AI tools to improve billing workflows, reporting accuracy, and department efficiency.
• Proactively seek opportunities to streamline and modernize billing operations.

SCHEDULE: Monday–Thursday, 7:30 AM – 5:30 PM (Fridays Off)

WORKING LOCATION: 1121 Louisville Rd. STE 501, Frankfort KY 40601

• Preferred that the candidate work in-office.
• Hybrid work from home 50/50 office split may be considered.

BENEFITS:

• Health, Vision, Dental Coverage
• 401k Retirement Plan
• 3-Day Weekends (Fridays Off)
• Paid Time Off (vacation, personal time, and holidays)
• Growth Opportunities within the organization

QUALIFICATIONS:

• At least 3 year medical billing experience required; behavioral health billing preferred.
• Distinguished computer skills required. Advanced proficiency in Excel, pivot tables, and report building.
• Strong EHR experience required. Must demonstrate ability to set up, configure, optimize, and build templates within EHR systems. AdvancedMD experience preferred.
• Experience working with Availity preferred.
• Familiarity with AI tools and a demonstrated desire to implement them into billing workflows.
• Self-motivated and accountable with the ability to build and maintain a structured billing department.
• Strong verbal, written, organizational, and communication skills.
• Bachelor's degree preferred but not required.

Job Type: Full-time

Pay: $42,000.00 - $60,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Application Question(s):

• Please list all of your relevant licensures and/or certifications.

Experience:

• credentialing: 1 year (Preferred)
• Medical billing: 3 years (Required)

Ability to Commute:

• Frankfort, KY 40601 (Required)

Work Location: In person