Senior Biling and Credentialing Specialist

Description:The following information provides an overview of the skills, qualities, and qualifications needed for this role.About Quest Health RPM Services At Quest Health RPM Services, we proudly stand as a premier provider of Continuous Glucose Monitors, committed to our noble cause of empowering individuals with diabetes to access the essential tools required for better health management. We strive to provide exceptional care for patients with diabetes using telecommunications. You will play a vital role in assisting healthcare professionals in delivering comprehensive and personalized diabetes care. Overview of the Role The?Senior Billing and Credentialing Specialist?plays a vital role in supporting the financial and operational integrity of our Remote Patient Monitoring (RPM) and telehealth services. This position is responsible for executing payer credentialing, billing workflows, denial resolution, and compliance monitoring to ensure accurate reimbursement and provider participation. This is a hands-on role ideal for someone with deep expertise in healthcare billing and credentialing, particularly in telehealth and RPM environments. The specialist will collaborate closely with clinical and operational teams to ensure clean claims, timely enrollments, and adherence to payer guidelines.  This is an in-office role in Coral Springs, FL. Key Responsibilities: Credentialing - Enroll new providers with Medicare, Medicaid, and all contracted commercial payers.- Maintain and update CAQH profiles, state licenses, malpractice insurance, and related documents.- Track expirations and renewal timelines to prevent lapses in participation.- Submit applications and revalidations accurately and on time. Billing & Revenue Cycle - Prepare and submit clean claims for RPM and telehealth services.- Monitor claims for accuracy and compliance with payer requirements.- Resolve denials, resubmit claims, and manage appeals to minimize revenue loss. Compliance - Ensure billing processes comply with CMS, HIPAA, and payer-specific rules.- Collaborate with clinical staff to ensure documentation supports billable services. Reporting & Collaboration - Maintain key performance indicators (KPI's) such as clean claim rate, and days in A/R.- Serve as a subject matter expert for billing and credentialing questions across the team. Other duties as assigned. Requirements: Requirements: 2+ years of experience in medical billing, credentialing, or revenue cycle management (RCM).  Strong knowledge of Medicare, Medicaid, and commercial payer requirements.  Remote Patient Monitoring or telehealth billing experience strongly preferred. Associate or bachelor's degree in healthcare administration, business, or related field preferred.  Proficiency with billing software, cleaning houses, and EMR/EHR systems.  Strong attention to detail and organizational skills. Excellent communication and ability to collaborate cross-functionally.  Benefits? Medical, Dental, and Vision Insurance? Life Insurance coverage? Paid time off and Holiday Pay? 401K with company match option? Growth opportunities? Join a team where your work has real impact.? Apply today and help transform the lives of people living with diabetes!? Why Quest Health RPM Services At Quest Health RPM Services we are not just a company; we are a community committed to providing unparalleled service to our patients and their families. Our mission is rooted in compassion, excellence, and a drive to innovate in healthcare. We believe in creating a work environment that fosters growth, supports ambition, and values every individual's contribution. We recognize our people drive everything we accomplish, and as such, we are dedicated to investing in our employees by fostering a culture of continuous learning, growth, and excellence. Our team works hard, and we recognize the importance of taking care of ourselves. We offer a comprehensive suite of benefit offerings to support the health, well-being, and financial health of our employees and their families. Our robust benefits package underscores our commitment to our people, our most important asset. Quest Health RPM Services seeks excellence through diversity in its staff. We prohibit discrimination based on race, color, religion, sex, age, national origin, sexual orientation, gender identity or expression, disability, veteran status, or marital status.  PI1d9bf8eb16ae-30134-38650922

Created: 2025-09-30