Credentialing and Billing Specialist

5 days ago


Edgewater, Maryland, United States Arundel Lodge Full time

Arundel Lodge seeks a skilled Credentialing and Billing Specialist to join our team. As a key member of our staff, you will be responsible for managing the credentialing process for healthcare providers, ensuring compliance with relevant regulations and laws.

The estimated salary for this position is $55,000 - $65,000 per year, depending on experience.

About the Role:

  • Maintain the CAQH provider database, including education, training, employment history, and credentialing status.
  • Work closely with the Billing Supervisor to prepare and submit credentialing applications to payers and health plans for employed and contracted healthcare providers.
  • Track and follow up on application statuses to ensure successful completion.
  • Manage the re-credentialing process for Arundel Lodge and its healthcare providers.
  • Maintain Arundel Lodge's Maryland Medicaid application (EPrep) and Medicare application (PECOS/NPPES), along with all other required licenses and applications for appropriate claim processing.
  • Stay updated on regulatory and legal changes to ensure compliance with relevant healthcare laws and credentialing standards.

Billing Responsibilities:

  • Track, request, and enter authorizations for Medical Assistance persons served through the Carelon provider portal.
  • Follow up with appropriate staff on authorization denials or requests for additional information.
  • Provide backup support for billing or data entry tasks as needed.
  • Enter insurance information for new residential persons served.
  • Verify Medical Assistance status for residential persons served and follow up as needed.
  • Receive and record customer payments, verify accuracy, and post them to appropriate accounts.
  • Issue monthly statements to persons served and respond to questions and complaints regarding bills.


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