Medical Biller and Credentialing Specialist

We are seeking an experienced, leadership-minded Virtual Medical Biller & Credentialing Specialist to support a busy mental health clinic led by Dr. Mann. In this critical revenue-recovery and operational oversight role, you will initially audit and monitor the output of an external, third-party medical billing company whose contract runs through April 2027. With approximately 90 days of pending billing and 500+ outstanding patient encounters, your mission is to identify claim bottlenecks, resolve billing errors, hold the external agency accountable, and directly recapture revenue for the practice.

In addition to revenue cycle management, you will lead and execute provider insurance credentialing across commercial, Medi-Cal, and Medicare payors. The ideal candidate possesses 3+ years of U.S. medical billing, coding, and credentialing experience, background managing or independently leading credentialing workflows, hands-on mastery of major payor portals (with Availity as top priority, alongside Optum and Medicare), and direct experience in a mental/behavioral health setting. This position starts as a part-time role (~20 hours/week) for the first month with a direct path to full-time employment as you take over full in-house billing and credentialing operations.

Working Environment & Core Schedule

• Role Title: Virtual Medical Biller & Credentialing Specialist
• Specialty: Mental Health / Behavioral Health Clinic
• Status: Part-Time (~20 Hours / Week for Month 1) transitioning to Full-Time based on revenue recovery and operational demand
• Schedule: Flexible 4–5 hours per day within Monday – Friday, 10:00 AM – 7:00 PM PST (Pacific Standard Time)
• Core Technology Stack: OnlyMD EMR & Billing System, Payor Portals (Availity, Optum, Medicare), CAQH ProView, Practice VoIP System, Dedicated Company Email Domain
• Primary Objective: Revenue recovery, clearing a 500+ encounter backlog, external billing agency audit, end-to-end provider credentialing, and claim resolution

Top 3 Daily Tasks

1. External Billing Agency Audit & Monitoring: Review daily submissions from the current third-party billing company, cross-referencing OnlyMD EMR encounters against filed claims to uncover unbilled encounters, coding errors, and dropped tasks.
2. Backlog Clearance & Payor Portal Follow-Up: Investigate 90 days of pending billing and 500+ unsubmitted encounters using Availity, Optum, and Medicare portals; communicate directly with payors and the billing agency to resolve rejections and denials.
3. Provider Credentialing & CAQH Management: Manage new and ongoing provider credentialing applications, re-credentialing cycles, CAQH profile attestations, and contract maintenance with California commercial and government payors.

Core Responsibilities

• Third-Party Agency Oversight: Serve as the practice’s internal watchdog—auditing the external vendor's work, tracking claim transmission cadences, and flagging systematic errors or delays.
• Provider Credentialing & Panel Management: Independently direct provider enrollment, re-credentialing, CAQH maintenance, and payor contracting across California health plans (Medi-Cal, Medicare, commercial payors).
• Payor Portal Operations: Leverage Availity (highest priority), Optum, and Medicare portals daily to check claim statuses, eligibility, claim adjustments, pre-authorizations, and enrollment updates.
• Mental Health Billing & Coding Audit: Ensure accurate CPT/ICD-10 coding for behavioral health encounters, therapy sessions, and psychiatric evaluations within OnlyMD.
• Claims Tracking & Denial Management: Identify root causes for unpaid, rejected, or unsubmitted claims; execute corrective actions, appeals, and resubmissions.
• Payor & Regulatory Compliance: Navigate complex California state medical billing and credentialing regulations, county/state-specific paperwork, and Medi-Cal guidelines.
• Full In-House Transition Preparation: Document billing and credentialing workflows to seamlessly transition 100% of operations in-house when the third-party contract concludes.

Requirements

• Must-Have / Non-Negotiable Qualifications
• 3+ Years Medical Billing, Coding & RCM Experience: Proven track record in AR follow-up, claims auditing, denial management, and medical revenue cycle management.
• Direct Mental Health Specialty Background: Mandatory prior experience working in a mental/behavioral health setting (psychiatry, psychology, therapy, or behavioral health clinics). General family medicine experience does not meet this requirement.
• Provider Credentialing & Leadership Experience: Proven hands-on experience independently managing provider credentialing, enrollment, and CAQH profiles, with prior experience working under a credentialing manager, leading credentialing workflows, or supervising team members.
• Payor Portal Mastery (Availity Priority): Deep, direct operational experience navigating Availity (must-have / highest priority), Optum, and Medicare portals for claims tracking and enrollment.
• California State & Payer Familiarity: Proven capacity to master state-specific billing rules, California payor guidelines (commercial, Medi-Cal, county programs), and local credentialing paperwork.
• Schedule Flexibility: Ability to work part-time (~20 hrs/week) across a flexible schedule within 10:00 AM – 7:00 PM PST, with full availability to transition to 40 hrs/week full-time.
• Remote Workspace Setup: Dedicated, private, quiet HIPAA-compliant home office equipped with a high-performance computer (PC/Mac), high-speed internet connection, backup internet/power solutions, and a headset.
• Preferred Qualifications
• Tier 3 mental health specialty billing/credentialing experience.
• Hands-on experience navigating OnlyMD EMR & Billing System (or comparable integrated EMR/billing platforms).
• Track record of successfully transitioning a clinic from an outsourced billing model to an in-house structure.

Ideal Candidate Profile

You are a sharp, leadership-minded medical billing and credentialing specialist who thrives on solving complex revenue puzzles. You know how to audit an external billing agency's work, navigate Availity and payor portals with ease, manage provider credentialing end-to-end, and untangle California mental health claims to build a high-performing in-house RCM department.