Medical Insurance AR and Credentialing specialist

1 month ago

Catonsville, United States THE UPS STORE Full time
Job DescriptionJob Description

Job Description :

The Credentialing and Insurance Follow-Up Specialist will be responsible for
administrative billing support including the following: Fluent English speaking and
written communication skills, good time management skills, and professional dress, speech, and
behavior are all required for this position.


The following is a representative list of the duties and responsibilities associated with this position:

~ Enroll and credential providers (e.g. physicians, facilities, physician
   assistants, nurse practitioners, etc.) with insurance companies
~ Clearly and effectively communicate with providers, practices and insurance
   Document credentialing and network status and communicate with
   practices to ensure patients are seen by credentialed and in network
   providers
~ Follow up with clients and insurances for timely credentialing process(es)
~ Review, and update, health plan directories, agencies, and other appropriate
   entities for current and accurate provider information
~ Maintain access to insurance and government payer portals and share with
   business contacts as needed
~ Knowledge of provider credentialing/accreditation/insurance regulations,
   policies, guidelines, and standards
~ Work with RCM team to determine the root cause for credentialing and
   payer network related denials from insurance carriers and develop solutions
   to resolve
~ Support payer contracting, escalations, and contract negotiation strategy as
   needed
~ Support payer setup in the PM/EMR system and clearinghouse for billing
~ Perform other duties as assigned
~ Submit Primary/Secondary Insurance and Follow-up on same.
~ Place Outbound Calls To Insurance for Status of Outstanding Claims.
~ Analyze Remittance/Explanation of Benefits.
~ Determine Correct Payment According To Hospital/Payer Contract.
~ Determine Patient Responsibility.
~ Submit Adjustment Claims, Submit Appeals for Underpayment and/or
   Denials.

~ Verify Insurance Coverage, Contact Guarantor Regarding Insurance
   Discrepancies.
~ Follow guidelines for MSPQ (Medicare Secondary Payer Questionnaire)
   Processing.
~ Ability to work flexible hours as determined by management.
~ Strong communication, documentation, follow up, analytical, and computer
   skill sets.
~ Familiarity with the Hospital’s Epic System A+. Ability to accurately update
   patient accounts, update
~ Insurance information, initiate insurance billing,
~ Performs other job-related duties, as required and assigned.

 

Qualifications:

~ High school degree or equivalent required. Bachelor’s degree in business, healthcare related
   field preferred or equivalent experience
~ Experience in credentialing or other medical experience relevant to insurance carrier
   credentialing
~ Excellent organizational skills
~ Strong analytic and problem-solving abilities
~ Excellent verbal and written communication skills
~ Able to maintain confidentiality.
~ Experience with Microsoft Office-Excel, Word, PowerPoint and the ability to master programs
    needed for position
~ Must be able to work independently

 

Note: 

We do work with the unemployment office. Please do not apply if you do not meet the Job
requirements.

 

 

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