Medical Billing and Credentialing Expert
4 weeks ago
Care Alliance Health Center is a leading provider of high-quality medical, dental, behavioral health care, and more. We have been serving the Cleveland community for over 35 years.
About the Job
Billing and Credentialing Specialist RoleWe are looking for an experienced and proven Credentialing & Billing Specialist to join our team. The ideal candidate will maintain accurate provider information, support billing operations, and ensure adherence to credentialing and billing guidelines.
Key Responsibilities:- Billing and Revenue Cycle Management:
- Accurately process and submit claims to insurance companies, Medicaid, Medicare, and other payers.
- Review and reconcile claims for errors or inconsistencies, ensuring compliance with payer guidelines and regulations.
- Follow up on denied or unpaid claims, identifying and resolving issues to maximize reimbursement.
- Assist in preparing and submitting appeals for denied claims in a timely manner.
- Monitor accounts receivable and generate reports for management to track billing performance.
- Credentialing and Provider Enrollment:
- Coordinate initial and re-credentialing processes for providers, ensuring compliance with payer requirements.
- Prepare and submit provider applications and maintain accurate documentation for insurance panel enrollment.
- Track credentialing statuses, renewal dates, and expiration deadlines to ensure continuity of participation in payer networks.
- Communicate with insurance carriers to resolve credentialing and enrollment issues promptly.
- Compliance and Documentation:
- Stay current on billing and credentialing regulations, payer policies, and coding updates to ensure adherence to industry standards.
- Maintain thorough and accurate records of all billing and credentialing activities, including contracts, applications, and communications.
- Assist in audits and quality assurance checks to ensure compliance with internal and external standards.
- Collaboration and Communication:
- Serve as a liaison between providers, insurance payers, and internal departments to facilitate efficient billing and credentialing processes.
- Educate providers and staff on billing and credentialing requirements as needed.
- Provide excellent customer service to patients and providers by addressing billing inquiries and resolving issues promptly.
- General and Finance:
- Bill for transportation charges
- Prepare daily deposits to be uploaded
- Open mail and disseminate by department
Requirements
Education and Experience- High School Diploma or equivalent required; Associate's degree in Business Administration, Healthcare Management, or related field preferred.
- Minimum of 2 years of experience in medical billing and credentialing, preferably in a community health center or healthcare setting.
- Proficiency in medical billing software, electronic health records (EHR), and Microsoft Office Suite.
- Strong understanding of medical coding (CPT, ICD-10) and payer requirements.
- Excellent organizational skills with the ability to manage multiple tasks and meet deadlines.
- Attention to detail and accuracy in billing, documentation, and reporting.
- Strong communication and interpersonal skills for effective collaboration with internal and external stakeholders.
- Certification in Medical Billing and Coding (e.g., CPC, CPB) or Credentialing Specialist (e.g., CPCS) preferred.
Estimated Salary: $55,000 - $65,000 per year, depending on experience and qualifications.
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