Insurance Credentialing Specialist

1 week ago

Gilbert, United States Lighthouse Psychiatry Brain Health Center Full time
About the Job:
We are a growing mental and behavioral health company based in Arizona's East Valley that is currently looking for qualified individuals to join our growing team. Lighthouse offers a positive and healthy work environment with opportunities to learn new clinical modalities, professional development opportunities, career advancement within the company, and be part of a healthy work environment. The Company:
Lighthouse Psychiatry (and its affiliate nonprofit Lighthouse Wellhealth) is dedicated to providing a patient-centric and quality-focused experience. Through a personalized approach to care delivery, we offer a customized treatment solution specifically tailored to the needs and challenges of the individual. Our patients have the benefit of utilizing a diverse collection of services including psychiatric medication management, specialized counseling (trauma, individual, couples, family, group), advanced TMS, Spravato (nasal esketamine), IV ketamine, ADHD testing and treatment, pharmacogenetics testing and evaluation, and photobiomodulation. Our goal is to provide a comprehensive and synergistic approach to patient care to maximize outcome and success. We approach patient care with the mindset that no two individuals are the same, hence no two treatment plan should be the same. Our nonprofit affiliate Lighthouse Wellhealth is dedicated to providing mental health services for kids at schools. Company Culture is like no other:We pride ourselves on our values. Our core values are rooted in Wellness, Empathy, Collaboration, Compassion, Commitment, Appreciation, Respect, and Empowerment (WE C3ARE). We strive to achieve and implement those properties to each and every patient who allows us to be a part of their care. We equally strive to extend those characteristics to our current and future team members. We strongly believe in a healthy work-life balance to ensure a positive emotional and mental wellbeing for everyone who commits to working at Lighthouse Psychiatry and the people and community we serve. Company Mission Statement:
Guided by our passion for our profession and our commitment to healing, we offer effective interventions to improve the emotional and mental well-being of patients. Through innovation and technology, we aim to decrease the stigma of mental illness, assist in the recovery and growth of individuals. At our core, we strive to continuously invest in people.
Job Description:The insurance credentialing specialist is responsible for overseeing the credentialing process for our clinicians.  Their duties include, but are not limited to, drafting and submitting applications, communicating with the insurance company to expedite the credentialing application process, negotiating higher reimbursement rates, updating CAQH, submitting supporting documents, and maintaining organization in the application process. 

Minimum Qualifications:
  • Some college or trade school education (in relevant field)
  • Certification in Medical Billing Services
  • Certification in Medical Coding (Preferred)
  • Two or more years of experience with credentialing
  • Working knowledge of the credentialing process
  • Working knowledge of different insurance credentialing requirements and procedure
  • Two or more years of relevant experience in the medical environment and facility
  • Two or more years of work experience in the field of mental health, behavioral health, or psychiatric care
  • Physically able to perform typing tasks on a computer, walk, stand, stoop, and bend
  • Possess interpersonal skills to work in a team structure
  • Strong communication skills
  • Proficient in English (oral and written)
Experience:
  • Experience with working insurance company provider relations and navigating credentialing process
  • Experience in multitasking and prioritizing responsibilities in a work environment
  • Experience with attention to detail and problem-solving in a work environment
  • Strong written, verbal, in-person, and telephonic communication skills
  • Experience working with patients in a medical or clinic environment
  • Experience working with mental health patients, experience working alongside mental health professionals
  • Strong organizational and planning skills
  • Ability to effectively work, communicate, support, and accepting of individuals of all backgrounds
  • Ability to work accurately, efficiently, and productively based on metric-based evaluations and assessments
  • Ability to maintain positive office etiquette
  • Ability to work effectively under pressure
  • Possess a warm and welcoming personality 
  • Maintain positive and constructive rapport with staff, providers, clients, and patients
  • Experience in establishing professional and emotional boundaries with patients and clients
  • Strong computational skills using PC and Mac computers
  • Strong understanding of Microsoft office software
Responsibilities:
  • Check and respond to voicemail, phone, text, and email messages promptly
  • Check and respond to internal office messages (ie. Slack), email, text, and phone messages promptly
  • Answer phone calls promptly and courteously, maintaining professionalism at all times
  • Utilize software to identify outstanding accounts
  • Minimize operator error with frequent re-check of work. Must report the error to supervisor/manager immediately
  • Generate statements and invoices to patients and clients
  • Process all payments using payment services
  • Reconcile all payments with each account
  • Send delinquent accounts to management
  • Regularly review billing and accounting data for accuracy
  • Verify patient insurance eligibility and benefits
  • Obtain referrals and authorizations from insurance companies for procedures and follow up visits
  • Follow up on unpaid and denied claims and submit appeals, when applicable
  • Audit all payment, accounting, and account inconsistencies or errors
  • Collaborate with patients, insurance companies, and other team members to resolve billing inconsistencies
  • Inform patients of any missed or upcoming payment deadlines
  • Input payment history or financial data into an individual account
  • Input detailed notes in EMR or any software
  • Collect fees and record information 
  • Scan all pertinent documents into patient charts (such as medical records, medical records requests, EOBs, claims, etc)
  • Check faxes: download to patient chart if needed and respond to them, fax inquiry appropriately
  • Document control: Scan/Fax documents/paperwork into patient charts
  • Follow up with client’s admin staff needs regarding billing concerns
  • Provide new and ongoing training supports to new and existing staff members, especially for quality assurance purposes
  • Provide new and ongoing training supports, under the direction of supervisor/manager, to new and existing externs for educational purposes 
  • Contribute to a positive work environment and positive rapport with patients, staff, and providers
  • Be professional and courteous when engaging and communicating with patients, clients, and visitors 
  • Maintain a high degree of accuracy regarding all details
  • Meet and coordinate with management to discuss workflow/procedures
  • Respect and maintain strict privacy and dignity of patients: assure patient confidentiality at all times (HIPAA)
  • Prepare and present reports to management
  • Perform other duties or follow up relevant to assigned project duties and responsibilities
  • Participate in ongoing staff and educational training and quality assurance and employee development processes
The Pay (variable):
  • The pay rate is negotiable and based on past experience, adaptability, and official certification(s).
The Location: 
  • Interview will take place at our Gilbert, AZ office.
Why Should You Apply?
  • Joining our team is joining a mission to make a meaning difference in people's lives, to advocate for mental wellness, and to make a purposeful impact in our community. We are committed to being the difference to make a difference.
  • This is an opportunity to work with a group of passionate, caring, and supportive professionals.
  • Staff work-life balance is a priority.
  • Opportunities for on-the-job training.
  • Opportunities for career growth within the company over time-based on availability and need.
  • Work in an environment that fosters personal growth.
  • In general, no weekend duties/responsibilities.
Ready to apply?
Please submit your resume and cover letter.
We look forward to meeting you

About Lighthouse Psychiatry Brain Health Center:

Lighthouse Psychiatry (and its affiliate nonprofit Lighthouse Wellhealth) is dedicated to providing a patient-centric and quality-focused experience. Through a personalized approach to care delivery, we offer a customized treatment solution specifically tailored to the needs and challenges of the individual. Our patients have the benefit of utilizing a diverse collection of services including psychiatric medication management, specialized counseling (trauma, individual, couples, family, group), advanced TMS, Spravato (nasal esketamine), IV ketamine, ADHD testing and treatment, pharmacogenetics testing and evaluation, and photobiomodulation. Our goal is to provide a comprehensive and synergistic approach to patient care to maximize outcome and success. We approach patient care with the mindset that no two individuals are the same, hence no two treatment plan should be the same.

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