Report

Billing and Credentialing Specialist

Min Experience

2 years

Location

Albuquerque, New Mexico, United States

JobType

full-time

About the job

Info This job is sourced from a job board

Overview

About the role

<div class="benefits"> <div>Benefits:</div> <ul> <li>Competitive salary</li> <li>Health insurance</li> <li>Paid time off</li> </ul> </div> <div class="trix-content"> <div> Position Overview Twilight Physician Group is seeking a highly organized and detail-oriented Billing and Credentialing Specialist to support a growing, innovative medical practice. This role is responsible for overseeing all aspects of medical billing, revenue cycle management, payer credentialing, and provider enrollment, ensuring financial sustainability and regulatory compliance across multiple care models. The ideal candidate thrives in a dynamic environment that integrates primary care, integrative medicine, access care, and facility-based services (e.g., assisted living). Key Responsibilities Billing & Revenue Cycle Management • Manage full-cycle medical billing operations: - Charge entry, coding review (CPT, ICD-10, HCPCS) - Claims submission (electronic and paper) - Payment posting and reconciliation • Monitor and follow up on: - Denied or rejected claims - Underpayments and payer discrepancies • Optimize accounts receivable (A/R) performance: - Reduce days in A/R - Improve clean claim rate • Verify patient insurance eligibility and benefits • Ensure compliance with: - CMS guidelines - Commercial payer requirements - New Mexico Medicaid policies • Generate regular financial and billing reports: - Revenue trends - Denial patterns - Provider productivity metrics Credentialing & Provider Enrollment • Manage initial and ongoing credentialing for all providers (MDs, PAs, NPs, integrative practitioners where applicable) • Complete and track: - CAQH profiles and attestations - Payer applications and revalidations • Maintain provider enrollment with: - Medicare - Medicaid (New Mexico-specific) - Commercial payers • Track credentialing timelines to prevent revenue disruption • Maintain accurate provider records, licenses, DEA registrations, and malpractice documentation • Support onboarding of new providers to ensure rapid go-live readiness Compliance & Documentation • Ensure adherence to: - HIPAA regulations - Billing compliance standards - Audit readiness (internal and external) • Maintain documentation for: - Credentialing files - Payer communications - Contracts and reimbursement rates Operational Support • Collaborate with: - Clinical leadership - Front desk staff - Practice management team • Assist with: - Workflow optimization - EHR/practice management system improvements • Support implementation of: - New service lines (e.g., integrative medicine, cash-pay services, memberships, medical marijuana evaluations) Qualifications Required • 2–5+ years of experience in medical billing and/or credentialing • Strong knowledge of: - CPT, ICD-10, HCPCS coding systems - Insurance claims processes - Medicare and Medicaid billing • Experience with payer credentialing and provider enrollment • Proficiency with: - EHR and billing systems (e.g., Athenahealth, Kareo, eClinicalWorks, or similar) • Strong attention to detail and organizational skills Preferred • Experience in multi-service or hybrid practice models (primary care + specialty + cash-pay) • Familiarity with: - Integrative/functional medicine billing - Direct pay, concierge, or membership-based models - Assisted living facility (ALF) billing • Certification: - Certified Professional Biller (CPB) - Certified Professional Coder (CPC) Key Competencies • Analytical thinking and problem-solving • Strong communication and follow-through • Ability to manage multiple priorities • High level of integrity and confidentiality • Process improvement mindset Compensation & Benefits • Competitive salary (based on experience) • Opportunities for growth within a rapidly expanding organization • Flexible work environment (potential hybrid/remote components) • Continuing education support About Twilight Physician Group Twilight Physician Group is a forward-thinking medical organization focused on delivering high-quality, patient-centered care across the continuum, including: • Primary care • Integrative and functional medicine • Access care • Assisted living facility care • Innovative service lines (e.g., wellness, medical cannabis evaluations) Our mission is to create a sustainable, collaborative, and healing-focused healthcare model that supports both patients and clinicians. Submit your resume to apply today! www.twilightmds.com</div> </div>

About the company

Provides compassionate hospice and palliative end-of-life healthcare services.

Skills

Athenahealth

Kareo

eClinicalWorks

EHR

Billing systems