Homeoffice Billing and Credentialing Manager bei Quest Health RPM Services

Description

About the role

The Billing & Credentialing Manager is a critical member of the Remote Care/RPM division, ensuring the business gets paid on time and providers remain credentialed with Medicare, Medicaid, and commercial payers. This person manages payer enrollment, billing workflows, denial management, and collections to maximize revenue and reduce compliance risks.
 

This is a hands-on, detail-oriented role requiring deep knowledge of healthcare credentialing and revenue cycle management, particularly for telehealth and Remote Patient Monitoring (RPM) services.

Primary Purpose

Manage all aspects of payer credentialing and revenue cycle activities in order to maximize clean claim submission, reduce denials, maintain compliance, and protect the company's revenue stream.

Key Responsibilities

Credentialing

- Enroll new providers with Medicare, Medicaid, and all contracted commercial payers.
- Maintain and update CAQH profiles, state licenses, malpractice insurance, and related documents.
- Track all expirations and renewal timelines to avoid lapses in participation.
- Ensure timely and accurate submission of applications and revalidations.

Billing & Revenue Cycle

- Prepare and submit clean claims for RPM and telehealth services.
- Monitor claims for accuracy and compliance with payer requirements.
- Work denials, resubmissions, and appeals promptly to minimize lost revenue.
- Partner with finance team to reconcile payments, adjustments, and collections.
- Support accounts receivable (A/R) management to reduce days outstanding.

Compliance

- Ensure billing processes comply with CMS, HIPAA, and payer-specific rules.
- Stay current on RPM billing requirements (e.g., patient consent, device coverage, time thresholds).
- Train staff as needed on documentation requirements that impact billing.

Reporting

- Track and maintain key KPIs including days in A/R, clean claim rate, denial rates, and collections.
- Provide weekly and monthly dashboards to the Director/VP of Virtual Care Ops and finance team.
- Highlight trends, risks, and opportunities for revenue improvement.

Collaboration

- Work closely with the Patient Care Manager to ensure clinical documentation supports billable services.
- Partner with the Director/VP of Virtual Care Ops to optimize workflows and ensure financial targets are met.
- Serve as a subject matter expert for billing and credentialing questions across the team.

Requirements

Experience
- 3+ years of experience in medical billing, credentialing, or revenue cycle management (RCM).
- Strong knowledge of Medicare, Medicaid, and commercial payer requirements.
- RPM or telehealth billing experience strongly preferred.

 - Associate or bachelor’s degree in healthcare administration, business, or related field preferred.
 

Skills
- Deep knowledge of credentialing workflows, CAQH, and payer enrollment processes.
- Proficiency with billing software, clearinghouses, and EMR/EHR systems.
- Strong attention to detail and organizational skills.
- Excellent communication and ability to collaborate cross-functionally.
- Problem-solving mindset with proven ability to reduce denials and improve collections.

At Quest Health RPM Services we are not just a company; we are a community committed to providing unparalleled service to our patients and their families. Our mission is rooted in compassion, excellence, and a drive to innovate in healthcare. We believe in creating a work environment that fosters growth, supports ambition, and values every individual's contribution. 

We recognize our people drive everything we accomplish, and as such, we are dedicated to investing in our employees by fostering a culture of continuous learning, growth, and excellence. Our team works hard, and we recognize the importance of taking care of ourselves. We offer a comprehensive suite of benefit offerings to support the health, well-being, and financial health of our employees and their families. Our robust benefits package underscores our commitment to our people, our most important asset. 

Quest Health seeks excellence through diversity in its staff. We prohibit discrimination based on race, color, religion, sex, age, national origin, sexual orientation, gender identity or expression, disability, veteran status, or marital status.  

Benefits 

• Medical, Dental, and Vision Insurance 
• Life Insurance coverage 
• Paid time off and Holiday Pay 
• Growth opportunities