Medical Insurance Credentialing Specialist

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Medical Insurance Credentialing Specialist based in Canada. We are seeking a detail-oriented Medical Insurance Credentialing Specialist to manage provider enrollment, credentialing, and medical billing operations in a remote healthcare environment. In this role, you will coordinate with insurance payers, healthcare providers, and internal teams to ensure accurate documentation, timely claims processing, and reliable reimbursement. You will oversee credentialing applications and renewals while maintaining compliance with payer requirements and applicable healthcare regulations. Your expertise in insurance billing, coding, and claims resolution will help minimize denials and prevent delays in provider network participation. You will also monitor payment discrepancies, maintain comprehensive records, and identify opportunities to improve revenue cycle processes. This is an opportunity to contribute to efficient healthcare administration while supporting providers and delivering operational accuracy. Accountabilities: As a Medical Insurance Credentialing Specialist, you will oversee the full lifecycle of provider credentialing, insurance enrollment, and claims management. You will ensure that provider records remain accurate, billing activities meet payer requirements, and reimbursement issues are addressed promptly through effective coordination and follow-up. - Prepare and submit credentialing applications for new healthcare providers across commercial insurance carriers, Medicare, Medicaid, and managed care organizations. - Manage provider re-credentialing within required timelines to prevent lapses in insurance network participation. - Maintain accurate provider information in credentialing databases, payer portals, and related systems. - Coordinate with providers to collect required documentation, professional licenses, certifications, and signatures. - Review, prepare, and submit medical insurance claims accurately using electronic health record (EHR) and billing systems.

- Apply appropriate CPT, HCPCS, and ICD-10 codes, including relevant modifiers, in accordance with applicable billing guidelines. - Verify patient demographics, insurance eligibility, and coverage details before submitting claims. - Apply payer-specific policies, fee schedules, and filing deadlines to support accurate and timely claims processing. - Monitor claim status through payer portals, manage claim edits and rejections, and coordinate necessary adjustments. - Post insurance payments, contractual adjustments, and write-offs accurately, identifying underpayments and payment discrepancies. - Reconcile daily, weekly, and monthly payment reports and maintain accurate billing records. - Investigate claim denials and rejections, prepare supporting documentation, and submit timely appeals. - Maintain detailed follow-up logs to track outstanding claims through resolution. - Ensure compliance with HIPAA, CMS requirements, payer policies, and applicable federal and state regulations. - Collaborate with clinical, administrative, and revenue cycle teams to resolve billing and credentialing issues. - Serve as a liaison between healthcare providers and insurance payers, resolving enrollment discrepancies and network participation issues. - Monitor changes in payer requirements, credentialing policies, and coding guidelines to maintain compliance. - Maintain credentialing logs, spreadsheets, databases, and expiration-date trackers to ensure deadlines are met. - Audit credentialing files for completeness and accuracy and prepare management reports on application progress, pending items, and compliance status. - Identify recurring payer issues and recommend process improvements to strengthen operational efficiency and reimbursement outcomes.