Billing and Credentialing Specialist
1 month ago
Pandya Medical Center is seeking an experienced Billing and Credentialing Specialist to join our team
Culture and Values:
At Pandya Medical Center, we believe in going above and beyond for every patient. Our team members are dedicated professionals who truly care about making a difference. We listen, understand, and treasure each personal story shared by our patients. Our commitment extends beyond our clinic walls, with active involvement in community health fairs and volunteering initiatives. We are a highly reputed medical practice in North Atlanta, offering strong growth opportunities and robust benefits for our employees. Be a part of our dynamic team and take your career to the next level with Pandya Medical Center
Essential Duties and Responsibilities
Credentialing:
- Review and process providers initial credentialing packets and supporting documentation.
- Follows up with provider to ensure all information is obtained prior to onboarding
- Completes and process payer enrollment applications for Providers for Medicare and submits required information to our PHO for credentialing for the remaining insurance carriers.
- Completes timely follow up on all applications.
- Maintains providers profiles and NPI’s, CAQH and internal spreadsheets.
- Ensure that re-credentialing is complete timely to prevent any lapse in enrollment.
- Monitor and maintain current documents (licenses, malpractice insurance).
- Maintain confidentiality of all providers information
Billing:
- Verifies coverage and eligibility as required and able to use insurance carrier portals for eligibility and claims information
- Post charges and payments to correct accounts
- Reviews patient bills and corrects any missing or inaccurate information in a timely and efficient manner
- Follows up on unpaid claims and clears up discrepancies by telephone, fax or email communication
- Investigate and appeal claims that were denied, following up and completing appeals in a timely manner
- Complete data entry to update spreadsheets and reports
Required Skills:
- Knowledge of insurance guidelines including HMO/PPO, Medicare and other payers’ requirements and systems
- Competent use of computer systems, software and EHR’s (Athena Preferred)
- Familiarity with CPT, ICD-10, and HCPCS Coding
- Experience with Family Practice billing (Preferred)
- Exceptional Customer Service skills for interacting with patients regarding medical claims and payments, including communication with patients and family members
- Ability to work well in a team environment
- Ability to triage priorities and handle conflict in a reasonable fashion
- Problem-solving skills to research and resolve discrepancies, denials, appeals, collections
- Knowledge of medical terminology likely to be encountered on medical claims
- Maintaining patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
- Ability to multitask
- Preferred at least 2 years recent medical billing experience
- Preferred at least 2 years credentialing experience
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