[Hiring] Billing/Credentialing Specialist @WOW Remote Teams

Role Description

This is a remote position. Our client is looking for a Billing/Credentialing Specialist to support medical billing operations, provider enrollment, credentialing, and payer-related processes within a growing virtual healthcare organization. They operate in the telehealth and remote care industry and have recently expanded technology-enabled programs that have produced measurable improvements in patient monitoring, care coordination, and hospital readmission outcomes.

• Manage medical billing activities, including claim creation, review, submission, and follow-up.
• Verify that claims contain accurate patient, provider, insurance, coding, and service information before submission.
• Monitor rejected and denied claims, identify the reason for nonpayment, and coordinate timely corrections or appeals.
• Follow up on outstanding accounts receivable and unresolved claims with insurance carriers.
• Post insurance and patient payments accurately within the billing or electronic medical record system.
• Review explanation of benefits and electronic remittance information to identify adjustments, underpayments, and denials.
• Confirm patient eligibility, insurance coverage, and authorization requirements when needed.
• Maintain accurate billing documentation and update account notes after each follow-up action.
• Coordinate the complete provider credentialing and recredentialing process.
• Prepare, submit, and monitor provider enrollment applications with Medicare, Medicaid, and commercial insurance plans.
• Maintain accurate provider information in credentialing databases and payer portals.
• Update and manage provider profiles through platforms such as CAQH, PECOS, and NPPES.
• Gather licenses, certifications, education records, insurance documentation, work history, and other supporting materials required for credentialing.
• Track application deadlines, expirations, renewals, and outstanding payer requests.
• Follow up with insurance carriers and credentialing organizations regarding application status and missing information.
• Maintain organized and audit-ready credentialing records.
• Communicate clearly with providers, internal team members, insurance representatives, and external partners.
• Protect patient and provider information in accordance with HIPAA and organizational privacy standards.

Qualifications

• Previous experience using the Athenahealth, AthenaOne EMR platform is required.
• Experience with CAQH, PECOS, NPPES, Medicare enrollment systems, and commercial payer portals is highly desirable.
• Familiarity with CPT, ICD-10, HCPCS, modifiers, and common medical billing terminology is an advantage.
• Experience supporting telehealth, remote patient monitoring, chronic care management, transitional care management, or physician practices is preferred.
• Knowledge of electronic claims, electronic remittance advice, clearinghouses, and payer-specific billing requirements is beneficial.

Requirements

• Proven experience in medical billing, provider credentialing, provider enrollment, or a closely related U.S. healthcare function.
• Working knowledge of the U.S. healthcare reimbursement process.
• Experience submitting and following up on claims with Medicare, Medicaid, and commercial insurance carriers.
• Understanding of claim denials, payment posting, accounts receivable follow-up, and insurance verification.
• Familiarity with provider enrollment, credentialing, and recredentialing processes.
• Ability to manage confidential patient and provider information in accordance with HIPAA requirements.
• Strong attention to detail and the ability to identify incomplete, inconsistent, or inaccurate information.
• Excellent organizational and documentation skills.
• Ability to manage multiple applications, deadlines, and follow-up activities simultaneously.
• Strong written and verbal English communication skills.
• Ability to work independently in a remote environment while maintaining consistent communication and accountability.
• Reliable internet connection and a professional remote workspace.

Benefits

• Full-time position.
• 100% remote opportunity for professionals located in LATAM.
• Long-term opportunity within a growing virtual healthcare organization.
• Exposure to both revenue cycle and provider credentialing operations.
• Opportunity to contribute to processes that support better patient access and continuity of care.