What are the responsibilities and job description for the Billing and Credentialing Coordinator position at Pacific Neuropsychiatric Specialists?
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Pacific Neuropsychiatric Specialists (PNS) is a leading mental health medical group dedicated to providing comprehensive treatment for a wide range of mental health conditions, including ADHD, depression, anxiety, bipolar disorder, schizophrenia, dementia, and more. Our services span adolescent and adult psychiatry, medication management, and psychotherapy.
At PNS, our employees are vital to our continued success. We strive to create an environment where team members find their roles rewarding, challenging, and impactful. We are committed to supporting professional development and invest in our employees through ongoing opportunities for learning and growth.
Job Summary:
The Credentialing and Billing Coordinator plays an essential, cross-functional role within our mental health organization. This position helps ensure timely access to care and smooth reimbursement processes by supporting both provider credentialing and patient insurance workflows. From enrolling clinicians with health plans to verifying patient benefits and authorizations, this role directly contributes to operational efficiency, compliance, and patient satisfaction.
This position is ideal for a proactive, detail-oriented professional with strong communication skills and a solid understanding of behavioral health billing and credentialing practices.
Key Responsibilities:
Credentialing
- Verify provider documentation and ensure it meets payer and contract requirements
- Maintain up-to-date provider rosters and credentialing trackers
- Prepare credentialing and recredentialing applications for individual providers and facilities (including Medicare, Medicaid, and commercial payers)
- Manage and update provider profiles in CAQH and payer enrollment portals
- Conduct periodic audits of payer forms and process documents to ensure accuracy and compliance
- Track the status of licensure, recredentialing, NPI registrations, and group enrollments
- Communicate with payers and providers to ensure the timely processing of applications
- Maintain organized digital credentialing records in accordance with accreditation and payer standards
- Support additional credentialing tasks as assigned
Billing
- Verify patient insurance eligibility and mental health benefits, including carve-outs, copays, coinsurance, deductibles, and authorization requirements
- Submit and track authorizations for services (routine, retroactive, and neuropsychological testing), ensuring documentation is submitted and approvals are received on time
- Accurately record authorization information in the patient’s chart and communicate updates to clinical and scheduling staff
- Enter and update accurate demographic and insurance data in the EMR (e.g., eCW)
- Collaborate with billing, front office, and credentialing teams to prevent delays or denials in claims
- Respond to billing inquiries from patients, internal staff, and insurance carriers in a timely and professional manner
- Provide clear communication to patients regarding their coverage, out-of-pocket costs, and financial responsibilities
- Act as a liaison between providers, payers, front office staff, and the billing department
Required Qualifications:
- High school diploma or equivalent (required); Associate's or Bachelor’s degree preferred
- Minimum 2 years of experience in healthcare billing or credentialing (preferably behavioral/mental health)
- Proficiency in EMR systems (eCW preferred) and insurance portals
- Strong understanding of commercial and government payer networks and requirements
- Excellent communication, organizational, and follow-through skills
Preferred Qualifications:
- Experience with mental health payer carve-outs and delegated networks (e.g., Carelon, Optum, MHN)
- Familiarity with CAQH, PECOS, Availity, and common payer enrollment platforms
- Experience submitting and tracking authorizations for mental health services
- Working knowledge of insurance verification workflows, including eligibility, benefits, and pre-authorizations
- Ability to support operational changes and assist with implementing process improvements across teams
