Billing and Credentialing Coordinator
2 weeks ago
Billing and Credentialing Coordinator
Full Time- Corporate Office- Hybrid
El Segundo, CA, US
Summary: The Billing and Credentialing Coordinator role supports a high-energy urgent care group by taking a hands-on approach to problem solving through critical thinking and effective communication. The Billing and Credentialing Specialist role works closely with both internal and external stakeholders to ensure provider enrollment requirements and billing activities are completed comprehensively and timely.
Major Responsibilities
•Process and submit provider enrollment applications to insurance companies, government agencies, and other relevant entities.
•Maintain a centralized, up-to-date database of provider enrollment information, ensuring confidentiality and accuracy.
•Monitor provider enrollment status from submission through completion, tracking expiring enrollments and initiating the re-credentialing process as needed.
•Serve as a liaison between internal teams, such as clinical, finance, and operations, to streamline processes for recurring and adhoc provider contracting and credentialing requirements.
•Collaborate with healthcare providers, the billing team, and insurance companies to obtain necessary documentation and resolve provider enrollment billing inquiries and issues.
•Create and maintain online payer portal access for provider enrollment purposes, as well as for billing and eligibility team members.
•Manage specialty billing programs to ensure accurate billing, timely follow up, and resolution of outstanding balances.
•Prepare and present adhoc and reoccurring reports to track performance, identify trends, and identify outstanding actions need to resolve provider enrollment or billing related matters.
•Assists with adhoc and reoccurring revenue cycle projects and other related duties as assigned
•Conforms to all applicable HIPAA, Billing Compliance, and organizational safety policies and guidelines.
Knowledge, Skills, Abilities and Other Qualifications
•Previous experience in medical billing and/or provider credentialing is required
•Familiarity with insurance plans, including Medicare, Medi-Cal, and commercial payers
•Basic knowledge of medical billing concepts such as CPT, HCPCS, Diagnosis and Procedure Codes
•Excellent attention to detail and accuracy in handling billing and credentialing processes
•Effective communication skills, both written and verbal, to interact with providers, insurance companies, and internal stakeholders
•Ability to multi-task and work well under pressure
•Advanced knowledge in MS Office programs including Excel
•High School diploma required, Associates degree strongly preferred
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