Medical Billing & Credentialing Specialist (Podiatry Practice)

Position Overview

We are seeking a highly detail-oriented and experienced Medical Billing & Credentialing Specialist to manage all aspects of the revenue cycle, with a strong focus on Medicare, Workers’ Compensation, No-Fault, and DME billing.

This role is critical to ensuring timely reimbursement, minimizing denials, and maintaining compliance across all payer types. The ideal candidate is proactive, organized, and experienced in navigating complex billing environments.

Key Responsibilities
Billing & Revenue Cycle Management
- Submit and manage claims for Medicare, Workers’ Compensation, No-Fault (PIP), and DME
- Ensure accurate coding (CPT, ICD-10, HCPCS) and documentation
- Monitor claims and follow up on unpaid/denied claims
- Handle appeals, corrections, and resubmissions
- Manage accounts receivable and reduce aging

DME Billing & Credentialing (High Priority)
- Handle DME billing (boots, braces, orthotics using HCPCS codes)
- Ensure compliance with Medicare DMEPOS requirements
- Manage DME credentialing (NPI, PTAN, payer enrollments)
- Track documentation (LMNs, proof of delivery, etc.)
- Apply correct modifiers (RT/LT, KX, GA, GY)
- Handle audits and documentation requests

Workers’ Compensation & No-Fault
- Manage full lifecycle of claims (submission ? follow-up ? collections)
- Handle authorizations and verifications
- Prepare documentation for appeals and disputes
- Communicate with carriers, attorneys, and administrators

Medicare Billing
- Submit compliant claims
- Resolve denials and audits
- Stay updated on Medicare policies

Credentialing & Enrollment
- Manage payer credentialing and re-credentialing
- Maintain CAQH and provider profiles
- Track expirations and ensure continuous participation

Reporting & Optimization
- Generate reports on A/R, collections, and denials
- Identify inefficiencies and improve workflows

Qualifications
- 2–3+ years of medical billing experience (podiatry/surgical preferred)
- Strong experience in:
• Medicare
• Workers’ Compensation
• No-Fault
• DME billing & credentialing
- Knowledge of CPT, ICD-10, HCPCS
- Familiarity with EHR systems (DrChrono is a plus)
- Strong follow-up and problem-solving skills

Performance Expectations
- Claims submitted within 24–48 hours
- Follow-ups within 7–14 days
- Reduction in denials and aging A/R
- Accurate DME documentation to prevent audits