Medical Billing, Eligibility & Credentialing Specialist

Job Description Medical Billing, Eligibility & Credentialing SpecialistWe are seeking a highly organized, detail-driven Medical Billing, Eligibility & Credentialing Specialist to support a growing behavioral health clinic that serves Medi-Cal and commercial insurance populations. This role is critical to ensuring clean revenue cycles, accurate insurance verification, timely reimbursements, and fully maintained provider credentialing across all payers.This is not a passive billing role. We need someone who understands how to actively manage insurance systems, anticipate issues before they become denials, and keep the financial and credentialing side of a clinic running smoothly and consistently.What You Will DoYou will oversee and manage the full insurance and billing lifecycle, including:Insurance Eligibility & VerificationRun and verify eligibility for Medi-Cal and commercial insurance plans prior to service datesConfirm authorizations, benefits, copays, deductibles, and coverage limitationsProactively identify coverage issues before appointments occurCommunicate eligibility findings clearly to clinical and administrative teamsBilling & Claims ManagementSubmit clean claims to Medi-Cal and commercial payers in a timely and accurate mannerMonitor claim status and follow up regularly to ensure prompt paymentIdentify, analyze, and resolve denied or rejected claimsCorrect and resubmit claims with accurate documentation and coding supportDenials ManagementTrack denial trends and identify root causesWork systematically to appeal and overturn denials when appropriateCreate processes to reduce repeat denials across providers and payersMaintain a clear log of all outstanding and resolved claim issuesCredentialing & Provider EnrollmentManage initial credentialing and re-credentialing for all providersMaintain up-to-date enrollment status with Medi-Cal and commercial insurance panelsTrack expiration dates, revalidation requirements, and documentation needsEnsure no lapse in active participation status for any provider or payerRevenue Cycle CoordinationCollaborate closely with clinical staff, intake, and administrative teamsEnsure insurance data is accurately entered and maintained in the systemHelp establish and maintain efficient billing workflows and SOPsSupport audit readiness and compliance standards What We're Looking ForThe ideal candidate is:Highly organized and able to manage multiple insurance workflows simultaneouslyExperienced in medical billing, eligibility verification, and insurance follow-upFamiliar with Medi-Cal billing processes and commercial insurance systemsComfortable working through denials and solving insurance-related issues independentlyDetail-oriented to the point of catching small errors before they become financial issuesConsistent, reliable, and able to maintain structured tracking systemsStrong communicator who can coordinate with clinicians and administrative teams Preferred ExperiencePrior experience in a medical or behavioral health clinicExperience with credentialing multiple providers across insurance panelsFamiliarity with electronic health record (EHR) systems and billing platformsExperience handling both high-volume claims and complex insurance casesKnowledge of revenue cycle management best practices Why This Role MattersThis position is central to the financial health and stability of our clinic. The right person will directly impact cash flow, reduce claim delays, and ensure providers are fully credentialed and reimbursable without interruption. We are looking for someone who doesn't just process billing—but actively owns and manages the insurance ecosystem of the clinic.