This position is responsible for credentialing medical staff and accounts receivable duties in our billing department. Candidate will maintain all medical staff members' current credentials and licenses to work legally in their field or specialty. Candidate will make or review all commercial, Medicare, Medicaid, and self-pay payments are posted from electronic remittances, daily mail, or any money collected during the process of assisting a patient.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other assignments, projects and duties may be required:
1. Maintenance of medical staff licenses and credentials
2. Create and maintain licensing, credentials, and insurance records.
3. Conduct research on updated state and federal regulations and policies
4. Release information to requesting agencies and public inquiries when required by law.
5. Help develop internal credentialing processes.
6. Monitor license and credential expiration dates and advise staff members of required “renew by” dates
7. Ensure the facility and staff members are maintaining compliance with regulatory and accrediting institutions
8. Maintenance of medical staff credentials in credentialing software, CAQH, PECOS, NPPES and GAMISS.
9. Post payments from various health plans using EMR software such as EClinicalWorks and Athena
10. Reconcile payments during payment posting.
11. Assist with End of Month reports.
12. Electronic billing, payment posting, and data entry experience.
13. Medical insurance terminology
14. Audit accounts for accuracy during payment posting process.
15. Follow all HIPAA regulations.
16. Knowledge of ICD-10 and CPT coding
QUALIFICATIONS:
Education: Some college or specialized training preferred.
Experience: At least three or more years medical staff credentialing and A/R experience required.
1. Knowledge of credentialing in CAQH, PECOS, NPPES and GAMISS software
2. Knowledge of hospital credentialing
3. Knowledge of medical billing/collection practices.
4. Knowledge of computer programs.
5. Knowledge of insurance regulations and requirements
6. Problem solving skills.
7. Knowledge of EMR systems
8. Knowledge of business office procedures.
9. Knowledge of basic medical coding and third-party operating procedures and practices.
10. Ability to operate a computer and basic office equipment.
11. Ability to read, understand and follow oral and written instructions.
12. Ability to establish and maintain effective working
13. Must be well organized and detail-oriented
We offer competitive compensation and benefits packages. Join our team of dedicated professionals in a supportive work environment where you can make a difference in patients' lives.
Job Type: Full-time
Expected hours: 40 per week
Benefits:
- 401(k)
- Dental insurance
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
Experience:
- Credentialing in a healthcare environment: 3 years (Required)
- Payment posting or accounts receivables in EMR software: 2 years (Required)
