Medical Billing and Credentialing Specialist

2 weeks ago

New York, United States Therapy Insights Practice Full time

JOB TITLE:
Medical Biller and Credentialing Specialist

COMPANY:
THERAPY INSIGHTS PRACTICE

POSITION TYPE:
Full-Time with benefits (can work remote)

PRACTICE WEBSITE:
SUMMARY OF POSITION:
Key Responsibilities:
Revenue Cycle Management:
Review and analyze medical records to accurately assign ICD-10-CM, CPT, and HCPCS codes for billing. Oversee the entire revenue process including claims submission, payment processing, denial management, and appeals to maximize revenue generation.

Claim Handling and Client Communication:
Utilize Availity for claim verification, upload Explanation of Benefits (EOBs) to client portals like TherapyNotes, and ensure clients are informed about their financial responsibilities.

Billing and Compliance Operations:
Manage patient information using electronic health records (EHR) and practice management software. Ensure compliance with industry standards and regulations using platforms like Alma and Headway to submit claims to major insurance providers (Aetna, Unitedhealthcare, Cigna, MagnaCare, BCBS).

Collaborative Documentation and Education:
Work with management and clinical staff to secure and verify necessary documentation for billing. Educate both clients and clinicians on proper billing codes and operational procedures, and provide support through responsive communication.

Benefits Analysis and Education:
Analyze benefit options to determine the most beneficial approach for clients, educating both clinicians and clients on the nuances of incident-to billing.

Supervision and Compliance Assurance:
Monitor and ensure that clinicians under supervision provide accurate insurance information to clients. Regularly reinforce documentation standards and address concerns with supervisory or HR personnel.

Billing Communications and Industry Compliance: Maintain active communication with insurance companies and patients to address billing queries and discrepancies. Keep abreast of changes in industry regulations and practices through ongoing education and professional development.

Direct Client Support:
Serve as the initial contact point for client billing inquiries, coordinating directly with insurance companies and partners such as Alma or Headway to enhance billing efficiency.

Financial Management and Auditing:
Prepare and distribute patient invoices, manage financial records, assist with remittance processing, and participate in audits and meetings with billing partners.

Credentialing and Internal Billing Integration:
Support clinicians through the credentialing process and ensure compliance with relevant standards. Transition billing processes to internal systems post-renegotiation of service rates to boost revenue.

Revenue Enhancement Strategies:
Identify and implement strategies to enhance billing practices and expand revenue opportunities within the practice.

Policy Development and Workflow Optimization:
Create and enforce office policies to streamline operations, enhance patient satisfaction, and ensure regulatory compliance.

Staff Development and Quality Assurance:
Conduct regular staff meetings and evaluations, offer training and coaching, and provide feedback to maintain high standards of service delivery, especially for new clinicians.

Regulatory Compliance and Certification Management: Ensure ongoing compliance with HIPAA and other regulatory standards, keeping the practice current with all necessary certifications and licenses.

Skill Requirements:
Pay: $21.59 - $26.00 per hour

Expected hours: 25 - 40 per week

**Benefits**:

- Dental insurance
- Health insurance
- Paid time off
- Vision insurance

Schedule:

- 8 hour shift

Work setting:

- Hybrid work
- Office
- Telehealth

**Experience**:

- Medical billing and Credentialing: 3 years (preferred)

Work Location: Hybrid remote in New York, NY 10018

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