Medical Billing and Credentialing Specialist

About the role:

Avita Integrative Care and Avita Psychological Care are psychology group practices serving New Jersey and New York. We are hiring an experienced specialist with a proven record in U.S. insurance billing, claims resolution, accounts receivable, and clinician credentialing.

Mental health billing is strongly preferred. Psychological or neuropsychological testing and assessment billing is a major plus.
You will join our existing remote billing team and collaborate with our intake coordinator, clinicians, and practice leadership.

What you will do:
- Perform Verification of Benefits (VOB) using our existing online platforms and payer portals, and make direct calls to payers when phone verification or clarification is needed. Document eligibility, covered services, client cost sharing, authorization requirements, and relevant limitations.
- Review and submit accurate claims using EHR systems (TherapyNotes); Independently resolve rejections, denials, underpayments, and unpaid claims through payer calls, corrected claims, reconsiderations, and appeals.
- Investigate and challenge insurance recoupments and clawbacks: assess payer reasons, coordinate supporting records, develop case-specific dispute and appeal strategies, and track response deadlines. Identify root causes and implement preventive checks for eligibility, authorizations, coding, provider enrollment, and documentation in collaboration with clinicians and billing colleagues.
- Monitor aging reports, prioritize overdue accounts and filing deadlines, and maintain a documented next action and follow-up date for unresolved claims.
- Review EOBs and ERAs, investigate payment discrepancies, and help reconcile posted payments and client balances.
- Handle clinician and group credentialing, payer enrollment, CAQH maintenance, re-credentialing, and group affiliations. Track applications through confirmed participation and effective dates.
- Resolve client billing questions with patience and clear explanations of insurance payments, deductibles, copayments, coinsurance, and balances.
- Coordinate assigned accounts and handoffs with other virtual billing colleagues; maintain accurate shared records and flag issues needing escalation.
- Monitor official payer updates affecting New York and New Jersey billing, telehealth, authorizations, testing, and provider eligibility; communicate relevant changes to the team.
- Provide weekly updates on aging balances, resolved claims, credentialing progress, and outstanding issues.

Required experience and skills:
- At least three years of direct U.S. medical insurance billing experience, including benefits verification, plus hands-on clinician credentialing and payer enrollment experience.
- Demonstrated success resolving denied or aging claims and completing insurance panel enrollments.
- Proven experience disputing insurance recoupments or clawbacks, developing effective resolution strategies, and implementing measures to reduce future recoupment risk.
- Current working knowledge of New York and New Jersey payer processes and the ability to independently verify plan-specific requirements.
- Working knowledge of CPT and ICD-10 terminology, modifiers, authorizations, EOBs, ERAs, coordination of benefits, and filing and appeal deadlines.
- Excellent spoken and written English, confident payer phone communication, respectful client service, and reliable collaboration with a remote team.

Especially helpful experience:
- Mental health or behavioral health group-practice billing.
- Psychological or neuropsychological testing billing, including authorizations, time and unit requirements, and primary and add-on code relationships.
- TherapyNotes, CAQH, Availity, clearinghouses, and payer portals.
- Aetna, Cigna or Evernorth, Horizon BCBS, UnitedHealthcare or Optum, Oxford, or Carelon.

Schedule and secure workspace:
You must be available throughout the agreed U.S. Eastern working hours for payer calls, client support, and team communication. The schedule follows U.S. Eastern Time, including daylight saving changes.

You will need:
- Reliable high-speed internet on a private, secured network, with a backup plan for internet and power interruptions.
- A modern computer capable of running multiple billing applications and voice or video calls reliably.
- A supported operating system with current security updates, security software, encrypted storage, multifactor authentication, and automatic screen locking.
- A quiet, private workspace, professional headset, and webcam.
- Familiarity with HIPAA confidentiality requirements and willingness to follow practice-approved security and remote access procedures.

How to apply:
Apply through OnlineJobs.ph with your resume and brief answers to these questions:
1. How many years have you handled U.S. insurance billing and credentialing? Which New York or New Jersey payers have you worked with?
2. Describe one denied or aging claim you resolved: the problem, your actions, and the result.
3. Describe one clinician credentialing or enrollment you completed: the payer, your responsibilities, and how you confirmed the effective date.
4. Describe an insurance recoupment or clawback you challenged: your strategy, the outcome, and steps you took to reduce future recoupment risk.
5. What mental health or testing billing experience and billing systems experience do you have?
6. Confirm your availability for the stated shift, earliest start date, expected rate, and computer, internet, and backup setup.
Use examples without patient identifiers or confidential employer information. Shortlisted applicants may complete a brief exercise using fictional billing scenarios.