Outpatient Credentialing Specialist/ AR Specialist
TMC
Homosassa, FL
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JOB DETAILS
SALARY
$20–$22
LOCATION
Homosassa, FL
POSTED
30+ days ago
Description
We are seeking a detail-oriented and experienced Outpatient Part B Credentialing Specialist / AR Specialist to support our revenue cycle operations. This role is responsible for managing provider credentialing and enrollment for Medicare Part B and commercial payers, while also overseeing accounts receivable follow-up to ensure timely reimbursement. The ideal candidate has strong knowledge of outpatient billing, Medicare regulations, and payer enrollment processes.
Key Responsibilities
Credentialing & Enrollment
- Manage Medicare Part B provider enrollment, revalidations, and updates through PECOS and other payer portals
- Submit and track provider credentialing applications with commercial and government payers
- Maintain CAQH profiles and ensure accuracy of provider data
- Monitor credentialing expirations and ensure timely renewals
- Communicate with payers regarding application status, missing documentation, and follow-ups
- Maintain provider credentialing files in compliance with regulatory standards
Accounts Receivable (AR) Management
- Perform timely follow-up on unpaid and underpaid outpatient claims
- Review denials and rejections, identify root causes, and initiate corrective action
- Submit appeals with appropriate documentation
- Post payments and adjustments accurately when needed
- Work closely with billing and coding teams to resolve claim issues
- Maintain aging reports and meet established AR performance goals
- Identify trends impacting reimbursement and report to leadership
Skills, Knowledge and Expertise
- Minimum 2–3 years of experience in Medicare Part B credentialing and/or outpatient AR
- Strong knowledge of Medicare Part B billing guidelines and outpatient reimbursement
- Experience with PECOS, CAQH, NPPES, and payer portals
- Familiarity with EHR and practice management systems
- Understanding of CPT, ICD-10, and HCPCS coding basics
- Strong analytical, organizational, and problem-solving skills
- Excellent written and verbal communication skills
- Ability to manage multiple priorities and meet deadlines
Preferred Qualifications
- Experience in outpatient therapy, physician practice, or rehab settings
- Knowledge of Medicare LCD/NCD policies
- CPC or CRCR certification (preferred but not required)
Key Competencies
- Detail-oriented and compliance-focused
- Strong follow-through and persistence with payers
- Confidentiality and HIPAA compliance
- Team-oriented with ability to work independently
Benefits
- Flexible Scheduling.
- CEU and State Licensure Reimbursements.
- 13 Days of PTO and 6 Paid Holidays.
- Plus one free Floating Holiday every year!
- Internal Growth and Leadership Opportunities.
- Mental Wellbeing Support Program.
- Health, Dental, and Vision.
- Retirement benefits (including 401k company match).
About the Company
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