Billing and Credentialing Specialist at TIDES FAMILY SERVICES INC

West Warwick, Rhode Island, United States -

Full Time

Start Date

Immediate

Expiry Date

15 May, 26

Salary

30.0

Posted On

14 Feb, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Billing, Credentialing, Claims Submission, Denial Resolution, Provider Credentialing, Payer Compliance, Account Reconciliation, Appeals, Benefit Verification, Eligibility Verification, CAQH Profiles, CPT Coding, ICD-10 Coding, HCPCS Coding, Microsoft Office Suite, Data Entry

Industry

Individual and Family Services

Description

Description Tides Family Services is a nonprofit organization that is committed to providing comprehensive support and resources to children, adolescents, and families facing various challenges. The overall mission of Tides is to provide services and supports that allow youth to live in a community-based setting. An "Agency Without Walls" our services are delivered in homes, communities, schools...wherever our youth are. Please note this is a part-time position. Position Overview: Tides Family Services is seeking a highly detail-oriented and proactive Billing & Credentialing Specialist to support the financial health and continued growth of our organization. This role is responsible for managing key components of the revenue cycle, including accurate claims submission, insurance follow-up, denial resolution, and provider credentialing. The Billing & Credentialing Specialist plays a critical role in ensuring timely reimbursement, maintaining payer compliance, and supporting sustainable operations. This position requires strong organizational skills, attention to detail, and the ability to work independently while managing multiple deadlines and payer requirements. The ideal candidate has experience in medical billing, insurance follow-up, and provider credentialing within a healthcare or behavioral health setting. They are solution-oriented, comfortable navigating payer systems, and committed to maintaining high standards of accuracy, accountability, and confidentiality. This is an opportunity to contribute meaningfully to a growing organization by strengthening revenue integrity and operational systems that directly support our clinical team and the families we serve. Essential Functions: Submit accurate and timely insurance claims (electronic and paper) Monitor claim status and resolve denials, rejections, and underpayments Post payments and reconcile accounts Conduct insurance follow-up and appeals as needed Verify patient benefits and eligibility Manage patient billing inquiries and payment plans Ensure compliance with payer policies and regulations Track and report key revenue cycle metrics Complete initial and re-credentialing applications for commercial and government payers Maintain CAQH profiles and ensure provider data is current Track credentialing timelines and follow up with payers Maintain accurate provider documentation and credentialing files Assist with contracting and payer communications as needed Requirements 2+ years of medical billing experience required Experience with provider credentialing and payer enrollment required Knowledge of CPT, ICD-10, and HCPCS coding Familiarity with commercial insurance and Medicaid processes Knowledge, Skills, and Abilities: Strong organizational and time management skills with attention to detail. Proficiency in Microsoft Office Suite (Word, Excel, Outlook) and comfort with data entry systems. Excellent written and verbal communication skills. Ability to multitask and work both independently and as part of a team. Experience with Echo Vantage preferred CPC certification (or similar) a plus Salary Range: $25.00-$30.00 per hour Compensation will be determined based on the candidate’s experience, education, language capacity, skills, and other qualifications relevant to the role, in alignment with organizational parity guidelines and market conditions. The requirements listed above are representative of the knowledge, skills, and/or abilities required to satisfactorily perform essential duties. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Tides Family Services is an Equal Opportunity Employer that values our diverse workforce and encourages all mission driven candidates to apply. We are a PBN Best Place to Work recipient, a Safe Zone Certified Employer, and a Veteran Friendly Employer. Join our team!

Responsibilities

This role manages key components of the revenue cycle, including submitting accurate insurance claims, resolving denials, posting payments, and conducting insurance follow-up and appeals. Additionally, the specialist is responsible for completing initial and re-credentialing applications for providers and maintaining accurate credentialing files.