Insurance Credentialing Specialist

2 weeks ago

Gilbert, Arizona, 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 team. Our company, Lighthouse Psychiatry Brain Health Center, 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.

Job Description

The Insurance Credentialing Specialist is responsible for overseeing the credentialing process for our clinicians. Their duties include drafting and submitting applications, communicating with insurance companies to expedite the credentialing application process, negotiating higher reimbursement rates, updating CAQH, submitting supporting documents, and maintaining organization in the application process.

Responsibilities
  • Check and respond to voicemail, phone, text, and email 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
Requirements
  • 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)
Why Should You Apply?
  • 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.

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