Healthcare Operations Coordinator (Intake, Billing, & Credentialing)

# **Administrative Specialist: Intake, Credentialing, and RCM/Billing Coordinator**

## ## Job Summary

Our established behavioral health practice is seeking a versatile, highly organized, and proactive individual to fill a critical hybrid role within our practice. **This position is structurally divided into three distinct core pillars: (1) Client Intake Coordination, (2) Provider Credentialing, and (3) Revenue Cycle Management (RCM)/Billing.** The ideal candidate will seamlessly transition between guiding new families through their initial onboarding journey, managing insurance paneling for our expanding clinical team, and overseeing the end-to-end medical/Medicaid billing lifecycle. This is an excellent opportunity for a comprehensive healthcare administrative professional who thrives on variety and owns the full operational workflow.

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## ## Key Responsibilities

### ### Part 1: Client Intake Coordination

* Act as the professional and compassionate first point of contact for prospective families inquiring about ABA therapy services.
* Conduct initial phone consultations and client screenings to assess service compatibility and family needs.
* Manage the full client intake pipeline, driving the process from initial inquiry to clinical case assignment.
* Gather and verify mandatory preliminary documents, including formal diagnostic reports, clinical evaluations, and medical prescriptions.
* Maintain proactive, empathetic, and clear communication with parents to ensure they feel supported during the onboarding process.

### ### Part 2: Provider Credentialing & Compliance

* Manage the complete credentialing, re-credentialing, and paneling lifecycle for our clinical team (BCBAs, LBAs, and therapists).
* Maintain, update, and regularly attest provider profiles within the **CAQH** database.
* Prepare, submit, and track comprehensive network applications to commercial insurance companies and Medicaid portals.
* Review and audit clinical provider enrollment contracts to verify active network status.
* Monitor clinical licenses, certifications, and malpractice policies to ensure zero lapses in regulatory compliance.

### ### Part 3: Revenue Cycle Management (RCM) & Billing

* Oversee the complete daily claims lifestyle, including electronic claims submission, payment posting, and clearinghouse audit tracking.
* Utilize specialized knowledge to navigate **Medicaid and Managed Care (e.g., Fidelis Care)** billing codes and state reimbursement guidelines.
* Review, appeal, and aggressively troubleshoot claim rejections, tracking errors, and insurance denials.
* Coordinate with the intake and clinical teams to secure, track, and monitor utilization rates of active insurance prior authorizations.
* Perform regular accounts receivable (A/R) follow-ups to ensure a clean, low-aging billing cycle.

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## ## Qualifications & Skills

* **Experience:** Minimum 2–3 years of professional experience in healthcare administration, explicitly handling a blend of intake, medical billing, or credentialing.
* **The Intake Skillset:** Exceptional communication and interpersonal skills, with the ability to explain complex insurance policies with empathy and clarity.
* **The Credentialing Skillset:** Solid understanding of CAQH, insurance paneling mechanics, and the administrative workflows required to get clinical staff in-network.
* **The RCM/Billing Skillset:** Mastery of medical insurance verification, authorization tracking, and hands-on experience submitting claims to **Medicaid and Managed Medicaid platforms**.
* **Systems & Tools:** High proficiency with electronic health records (EHR/practice management platforms) and online insurance portals.
* **Organization:** Meticulous attention to detail and sharp multi-tasking skills required to manage three independent administrative tracks smoothly.