Credentialing and Billing Specialist

1 month ago

Decatur, United States Positive Impact Health Centers INC Full time
Job DescriptionJob DescriptionDescription:

Are you seeking a career with a growing company, a place where you can make an impact in the community? Then Positive Impact Health Centers is the company for you.


Positive Impact Health Centers (PIHC) is a community leader in providing HIV prevention, care and treatment services located in Metro Atlanta. The PIHC model of care assures that clients have access to medical, pharmacy, dental, behavioral health and social services, providing the best opportunity for patients to achieve high-quality health outcomes. Services are provided on-site and through telehealth.


What makes us different? We offer our employees the following:

· 1 Health Wellness day per quarter

· Parental Leave

· Free parking at our locations/bus line accessibility

· Competitive Salary & Benefits

· Automatic 3% Safe Harbor & 2% Profit Sharing (Retirement Program)

· 100% allotted for benefit elections for employees, 50% allotted for benefit elections for employee's spouse/dependent

· Credit Union

*Proof of Covid-19 vaccination is required*



Job Summary: The Credentialing and Billing Specialist is responsible for maintaining active status for all Providers by successfully completing initial and subsequent credentialing packages as required by commercial payers, Medicare and Medicaid. This role is also responsible for medical billing, & coding, processing claims for Medicare, Medicaid, and commercial insurance. This role is also involved in improving current billing procedures and reducing A/R days.

Requirements:

Summary of General Duties:

· Maintains individual Provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications.

· Maintains internal Provider grid to ensure all information is accurate and logins are available.

· Updates each provider’s CAQH database file timely according to the schedule published by CMS.

· Applies for and renews annually all Provider licenses; Professional, DEA, Controlled Substance

· Completes revalidation requests issued by government payers.

· Completes Credentialing applications to add Providers to commercial payers, Medicare, and Medicaid.

· Completes re-credentialing applications for commercial payers.

· Credential new Providers and re-credential current providers with the locations where they hold staff privileges

· Works closely with the billing staff to identify and resolve any denials or authorization issues related to provider Credentialing.

· Maintains accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases.

· Basic understanding of medical ICD 10 codes and CPT medical billing codes.

· Good telephone and patient relation skills. Detail oriented and ability to prioritize work.

· Basic Knowledge of Ryan White's HIV/AIDS program is essential.

· Ability to collect, synthesize and research complex or diverse information.

· Ability to establish and maintain effective working relationships with a variety of Clients who are living with HIV/AIDS in order to collect, verify, organize and analyze information to determine eligibility for health insurance coverage.


Knowledge, Skills, and Abilities:

  • Experienced in working with culturally diverse populations
  • Must have great communication skills, (writing, spelling, listening and speaking) and interpersonal skills
  • Must have strong computer system skills, and have a positive, friendly and helpful demeanor
  • Must have excellent customer service skills and warm personality
  • Must have ability to work in a fast-paced environment and pay attention to detail
  • Ability to maintain high level of confidentiality at all times
  • Ability to follow all assigned tasks through to completion
  • Ability to multi-task, be detail oriented, be support focused
  • Ability to work as a team member
  • Ability to resolve problems
  • Ability to work well independently

Certification/Licensure:

Certified Provider Credentialing Specialist (CPCS) preferred


Education and Experience:

Associate’s Degree (Bachelor’s Degree in Business or related field preferred),

2 years of credentialing experience and two years of experience as a Medical Biller/Coder or any equivalent combination of training and experience that provides the required knowledge, skills, and abilities.

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