The Credentialing/Billing Specialist is responsible for supporting the development and implementation of the Credentialing process - credentialing new and established health care providers. The Credentialing/Billing Specialist will be expected to manage the billing cycle and a broad range of the billing processes. Billing will proactively work to maximize accurate and timely payment.
*CAQH Credentialing experience preferred*
*Not a remote position - in office only*
Essential Duties and Responsibilities
- Supporting the development and implementation of the Credentialing Processing Center policies and procedures
- Responsible for credentialing new and established health care providers, and maintenance of information to include primary source verification, follow up, data collection, data entry, and document review
- Compliance with HMA policy and procedure, Federal and State regulatory and accrediting agencies
- Process and maintain credentialing and re-credentialing in accordance with State and Federal Regulatory regulations
- Monitor collection of all information received; follow up on missing items and/or incomplete form
- Identifies and evaluates potential red flags and works in collaboration with practitioner to document the issue and physician response
- Verifying accuracy of billing data and revising any errors
- Timely resolution of all claims including appeals.
- Other duties as assigned
Other Duties as Require include the following.
- Ability to effectively communicate with providers of all specialties
- Exceptional customer service principles and practices to both internal and external customers
- Skilled in multi-tasking while managing multiple priorities
- Ability to adhere to confidentiality standards and professional boundaries at all times
- Attention to detail
Education: Associate degree or equivalent years’ experience
Full-time benefits: health, dental, vision, PTO - and much more!
Hours: 8am-5pm
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Job Type: Full-time
Pay: $45,000.00 - $55,000.00 per year
Benefits:
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
- Monday to Friday
Education:
Experience:
- Medical billing: 2 years (Preferred)
- Medical Credentialing Specialists: 2 years (Required)
Work Location: In person