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Credentialing and Billing Coordinator
Physical Therapy & Sports Medicine Centers. Lead insurance credentialing for PTSMC providers and locations .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in insurance credentialing processes, including managing EMR signature rules, maintaining CAQH records, and resolving claims denials. Proficient in ICD-10 and CPT coding, with a strong understanding of payer guidelines and billing practices.
Highest-signal resume keywords
Insurance CredentialingICD-10 Diagnosis CodesCPT Billing CodesClaims Denial ResolutionPayer Guidelines
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Insurance ParticipationContract ReimbursementBilling ModifiersNon-Reimbursable CodesProvider Demographic Verification
Soft Skills
Detail-OrientedProblem-Solving AbilityCollaborative Work
Tools & Technologies
EMR Systems
Industry Keywords
Claims SubmissionCAQH RecordsBilling IssuesInsurance Policy Changes
About the role
Key responsibilities & impact- Lead insurance credentialing for PTSMC providers and locations
- Credential all individual clinicians and provide timely updates
- Manage EMR signature rules to facilitate accurate and clean claims submission
- Provide insurance carriers with information needed to re-credential current clinicians and locations
- Maintain CAQH records for current PTSMC clinicians
- Complete applications and learn the credentialing process for participation with new networks
- Initiate temporary permit processes and follow up on status when applicable
- Track license transfers and follow up as needed
- Complete quarterly provider and demographic verifications for participating insurances
- Resolve missing or incorrect provider demographic information with payers
- Filter and submit claims from the In-Review work queue daily
- Correct failed edits, claim rejections, and insurance changes
- Resubmit modified or corrected charges after claim addenda are complete
- Manage self-pay visits by reviewing patient charges and creating remits to close out visits
- Remain current with insurance participation, contract reimbursement, payer guidelines, and policies
- Update insurance information and rebill claims to resolve billing issues
- Monitor billing on hold for new non-credentialed providers
- Review and resolve claims denials related to provider participation
- Keep informed of insurance policy changes through website updates and insurance newsletters
- Assist with coordination and communication of insurance information for accurate billing
Requirements
What you’ll need- Detail-oriented
- Problem-solving ability
- Ability to work collaboratively
- Working knowledge of ICD-10 diagnosis codes
- Working knowledge of CPT billing codes
- Knowledge of billing modifiers
- Knowledge of non-reimbursable codes
- Knowledge of insurance participation, contract reimbursement, payer guidelines, and policies
Benefits
Comp & perks- 401(k)
- Dental insurance
- Disability insurance
- Health insurance
- Life insurance
- Paid time off