Credentialing and Claims Specialist

Role Overview

• Manage rejected claims follow-up and resolution
• Track claim submissions and monitor for denials or rejections
• Investigate claim issues and coordinate corrective actions
• Communicate directly with insurance companies regarding billing and reimbursement concerns
• Handle insurance credentialing fixes and provider enrollment issues
• Ensure provider credentialing remains updated and active within insurance systems and Tebra Care
• Process insurance verification and eligibility checks
• Support copay collection and insurance coordination workflows
• Manage prior authorization workflows
• Transfer patient information from Zocdoc into Tebra EMR
• Assist with schedule management and calendar optimization
• Maintain organized follow-up systems and documentation tracking
• Collaborate closely with internal staff to support operational efficiency

Requirements

• Strong experience with medical billing, claims processing, and insurance workflows
• Expertise handling claim denials, rejected claims, and underpayments
• Prior credentialing experience is REQUIRED
• Experience communicating directly with insurance companies regarding claims and credentialing issues
• Strong attention to detail and organizational ability
• Ability to independently manage multiple follow-ups and deadlines
• Professional written and verbal communication skills
• Collaborative mindset and ability to work effectively with internal staff
• Must-Have Experience: Tebra Care (required), Familiarity with multiple EHR/EMR systems, Experience working with insurance portals and billing systems
• Technical Setup: Tebra EMR access, Google Voice phone system integration
• Preferred Experience: Background in behavioral health or mental health practices, Experience with prior authorizations and insurance verification workflows, Familiarity with patient scheduling and administrative coordination
• Basic requirements: Must be proficient in speaking and writing English very clearly, Must have relevant work experience, Be able to submit an NBI clearance and/or Local Police Clearance background check before onboarding [mandatory], Must be available for video meetings with your camera on (when needed)

Benefits

• Dedicated HR & Contractor Support Team: Access to world-class support for questions, guidance, contract matters, and client communication.
• Premium VPN Access (Optional): A secure VPN license can be provided upon request to enhance privacy and security for client-related tasks.
• HIPAA & Cybersecurity Training + Certification (Provided): Access to our internal HIPAA compliance training, cybersecurity modules, and certification to help you confidently handle PHI for U.S. healthcare clients.
• Top 1% VA Performance Training: Access to our proprietary training on communication, client management, productivity systems, and best practices to help you become a top-performing VA and increase long-term client retention.
• Client-Approved U.S. Holidays: Contractors may take U.S. holidays off according to the client’s needs and schedule.
• Client-Approved Paid or Unpaid Time Off: Time off may be granted by your client. Paid time off is optional and only if offered by the client.
• Access to Tools & Resources: Templates, workflow guides, productivity tools, and client-specific SOP support to help you perform at your best.
• Optional Performance-Based Incentives: Some clients may offer bonuses, incentives, or increased hours based on your performance.