Medical Billing, Eligibility & Credentialing Specialist

Job Description

Job Description

Medical Billing, Eligibility & Credentialing Specialist

We are seeking a highly organized, detail-driven Medical Billing, Eligibility & Credentialing Specialist to support a growing behavioral health clinic that serves Medi-Cal and commercial insurance populations. This role is critical to ensuring clean revenue cycles, accurate insurance verification, timely reimbursements, and fully maintained provider credentialing across all payers.

This is not a passive billing role. We need someone who understands how to actively manage insurance systems, anticipate issues before they become denials, and keep the financial and credentialing side of a clinic running smoothly and consistently.

What You Will Do

You will oversee and manage the full insurance and billing lifecycle, including:

Insurance Eligibility & Verification

• Run and verify eligibility for Medi-Cal and commercial insurance plans prior to service dates

• Confirm authorizations, benefits, copays, deductibles, and coverage limitations

• Proactively identify coverage issues before appointments occur

• Communicate eligibility findings clearly to clinical and administrative teams

Billing & Claims Management

• Submit clean claims to Medi-Cal and commercial payers in a timely and accurate manner

• Monitor claim status and follow up regularly to ensure prompt payment

• Identify, analyze, and resolve denied or rejected claims

• Correct and resubmit claims with accurate documentation and coding support

Denials Management

• Track denial trends and identify root causes

• Work systematically to appeal and overturn denials when appropriate

• Create processes to reduce repeat denials across providers and payers

• Maintain a clear log of all outstanding and resolved claim issues

Credentialing & Provider Enrollment

• Manage initial credentialing and re-credentialing for all providers

• Maintain up-to-date enrollment status with Medi-Cal and commercial insurance panels

• Track expiration dates, revalidation requirements, and documentation needs

• Ensure no lapse in active participation status for any provider or payer

Revenue Cycle Coordination

• Collaborate closely with clinical staff, intake, and administrative teams

• Ensure insurance data is accurately entered and maintained in the system

• Help establish and maintain efficient billing workflows and SOPs

• Support audit readiness and compliance standards

What We’re Looking For

The ideal candidate is:

• Highly organized and able to manage multiple insurance workflows simultaneously

• Experienced in medical billing, eligibility verification, and insurance follow-up

• Familiar with Medi-Cal billing processes and commercial insurance systems

• Comfortable working through denials and solving insurance-related issues independently

• Detail-oriented to the point of catching small errors before they become financial issues

• Consistent, reliable, and able to maintain structured tracking systems

• Strong communicator who can coordinate with clinicians and administrative teams

Preferred Experience

• Prior experience in a medical or behavioral health clinic

• Experience with credentialing multiple providers across insurance panels

• Familiarity with electronic health record (EHR) systems and billing platforms

• Experience handling both high-volume claims and complex insurance cases

• Knowledge of revenue cycle management best practices

Why This Role Matters

This position is central to the financial health and stability of our clinic. The right person will directly impact cash flow, reduce claim delays, and ensure providers are fully credentialed and reimbursable without interruption. We are looking for someone who doesn’t just process billing—but actively owns and manages the insurance ecosystem of the clinic.