Medical Billing and Credentialing Professional
4 days ago
Care Alliance Health Center, a leading provider of high-quality medical, dental, and behavioral health care, seeks an experienced Medical Billing and Credentialing Specialist. With over 35 years of serving the Cleveland community, we are committed to delivering comprehensive medical and dental care, patient advocacy, and related services to those in need.
About the JobWe are looking for a skilled professional to maintain accurate provider information, support billing operations, and ensure adherence to credentialing and billing guidelines. This role will be responsible for managing all billing and credentialing activities to ensure timely and accurate claims processing and provider enrollment with insurance payers.
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.
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