Medical Licensing and Credentialing Specialist (Remote)

Heyday Health is seeking a highly organized and detail-oriented Medical Licensing and Credentialing Specialist to join our rapidly growing company. We are a virtual-first primary care practice dedicated to improving the primary care experience for seniors as well as our providers. We founded Heyday Health because we saw the health system leaving our elderly loved ones behind and were driven to create a better solution. Our practice is being built from the ground up with the mission of transforming how, where, and when we deliver care to achieve exceptional outcomes.

An ideal candidate for this role also possesses some experience in patient invoicing and medical coding. The Licensing and Credentialing Specialist will be responsible for managing the medical licensure and credentialing processes for physicians (MDs), advanced practice providers (APPs) and nurses, while also supporting the medical billing and coding functions to ensure compliance, accurate patient invoicing, and reimbursement. This position will require strong knowledge of regulatory requirements, insurance processes, and coding standards (CPT, ICD-10, HCPCS). The role will include, but not be limited to the following responsibilities: 

Licensing & Credentialing:

• Manage and coordinate the licensing process for all MDs and APPs, ensuring compliance with state and federal requirements.
• Handle the credentialing process with insurance carriers and medical groups, ensuring timely and accurate verification and approvals.
• Maintain up-to-date knowledge of healthcare regulations, medical board requirements, and payer policies regarding credentialing.
• Prepare and submit all necessary documentation for initial credentialing, re-credentialing, and privileging of providers.
• Coordinate with hospital systems, payer organizations, and other third-party entities to ensure credentialing requirements are met.
• Monitor and track expiration dates for medical licenses, certifications, and provider credentials, and initiate renewal processes as required.
• Run monthly sanctions and expirables reporting for all licensed medical staff

Invoicing & Billing:

• Assist with the generation and review of patient invoices to ensure they are accurate, compliant, and reflect the services provided.
• Work with our Medical Coder to obtain accurate procedure and diagnosis information for invoicing purposes.
• Collaborate with insurance companies to resolve patient billing issues, denials, and appeals.
• Process payments, manage billing discrepancies, and ensure that charges are entered correctly into the practice management system.
• Support our Medical Coder to review and maintain billing codes (CPT, ICD-10, HCPCS) to ensure proper reimbursement for services rendered.
• Communicate with patients regarding outstanding balances, billing questions, and payment plans.

Medical Coding (Certificate not required):

• Apply appropriate medical codes (CPT, ICD-10, HCPCS) for diagnoses, procedures, and treatments in accordance with current coding guidelines and payer-specific requirements.
• Ensure accurate and timely submission of claims to insurance carriers.
• Monitor claim rejections and denials related to coding errors, and assist in resolving issues promptly.

Compliance & Reporting:

• Ensure compliance with all state, federal, and payer regulations regarding licensure, credentialing, coding, and invoicing.
• Stay up to date with changes in healthcare laws, regulations, and coding systems.
• Assist in the development of internal policies and procedures related to credentialing, billing, and coding to ensure consistent and compliant practices.
• Provide reports as needed for internal and external audits or compliance reviews.

Other Duties:

• Serve as the primary point of contact for all credentialing and billing inquiries for MDs and APPs.
• Provide training or support to new staff members on credentialing, coding, and billing practices.
• Assist with administrative tasks related to provider onboarding and offboarding as needed.
• Collaborate with other departments, including operations, finance, and clinical teams, to ensure seamless administrative processes.

Required Qualifications

• Valid U.S. work authorization
• High school diploma or equivalent required; Associate's or Bachelor's degree in Health Administration, Business, or related field preferred.
• Certified Provider Credentialing Specialist (CPCS) or similar credentialing certification preferred.
• Minimum of 3 years’ experience in medical credentialing, licensing, and provider enrollment.
• Knowledge and experience with medical coding (CPT, ICD-10, HCPCS) and patient invoicing is preferred.
• Familiarity with payer systems, including Medicare, Medicaid, and private insurance plans.

We think you’d be a great fit if you're excited to roll up your sleeves to build something special. In addition, you have:

• Strong attention to detail and organizational skills.
• Ability to manage multiple tasks and meet deadlines.
• Excellent communication skills, both written and verbal.
• Strong problem-solving and critical thinking skills.
• Ability to work independently and as part of a team.
• Knowledge of HIPAA regulations and confidentiality requirements.

COVID-19 Considerations: We are a virtual-first team, however we require all providers and employees to be fully vaccinated, unless granted a religious or medical exemption. Full PPE is provided for any face-to-face interactions. 

Benefits Include:

• Monthly wellness stipend
• Flexible and generous PTO
• Health insurance benefits
• Paid parental leave 
• Contingency child care reimbursements 
• 401k and 401k matching
• Professional development support

Job Type: Full-time, permanent

Location: Remote, USA

Salary Range: $47,000 - $51,000 per year