Credentialing and Billing Specialist
Location: Kalamazoo Michigan
Description: Family Health Center is presently looking of Credentialing and Billing Specialist right now, this vacancy will be placed in Michigan. Further informations about this vacancy opportunity please read the description below. Credentialing & Billing Specialist
Summary of Duties: Responsible for coordinating and maintaining the credentialing, re-credentialing and enrollm! ent process for facilities, medical staff, mid-level practitioners, dental providers and any other licensed independent practitioners (LIPs) from other disciplines whose services are offered through the Family Health Center. Assists Patient Accounts / Billing with duties as assigned.
Duties require a thorough knowledge of Family Health Center policies and procedures in order to gather, verify and evaluate confidential provider data and documentation, prepare reports, answer correspondence and conduct research projects. Ensures compliance with accrediting and regulatory agencies (i.e. Joint Commission). Ensures providers are credentialed, appointed, and privileged with insurance or health plans, hospitals and patient care facilities. Maintain up-to-date data for each provider in credentialing databases, files and online systems. Assignments are planned and executed with considerable independence in compliance with established policies and procedures, bylaws, regulat! ions, and laws.
Essential Duties and Responsibilit! ies include the following:
Maintains knowledge of standards of the Joint Commission on Accreditation of Healthcare Organizations, National Committee on Quality Assurance, State and Federal regulations, and other governing organizations as related to Family Health Center.
Strategize and assist in establishing systems, processes and methodology for credentialing and enrollment.
Maintains open communication with the staff, Administration, Family Health Center departments, practitioners office staff, related health agencies and insurance companies. Identifies and works to solve problems as they arise.
Maintains working knowledge of the Family Heath Centers bylaws, rules and regulations, and policies, and works to ensure the staffs compliance with the stated parameters.
Assists with the on-boarding process in relation to credentialing and enrollment processes of Medical, Dental and other Provider candidates. Provides credentialing education and training t! o Family Health Center staff.
Provides supportive services to Family Health Center leaders in fulfilling the responsibilities of their offices. Participates with same in developing policies under the direction of the Patient Accounts and Billing Manager for the Family Health Center and in monitoring the continuity of Family Health Center activities.
Processes facility applications in accordance with accreditation standards, regulatory requirements, and policies and procedures.
Verify, research, and respond to telephone inquiries and written inquiries, from providers, insurance companies and other departments, pertaining to credentialing and enrollment status in a professional and courteous manner.
Provide credential information as directed to insurance companies, government programs, and collaborating organizations or programs as directed.
Maintain all additions, terminations, and changes to all insurance plans as appropriate.
Update and maintain ins! urance and communicate accordingly.
Prepare and submit insurance fo! rms to insurance agencies, including ensuring Medicaid enrollment for new providers.
Creation and/or update of the CAQH, CHAMPS, BCBS, PECOS and other insurance web-based system profiles as necessary. Maintaining this information to keep it up to date for the organization and individual providers.
Produces billing and/or enrollment related reports for the department.
Reviews chart notes and review appropriate codes to all claims regarding symptoms and procedures for physician services performed in locations other than the physician practice.
Responsible for processing all receipts by working closely with other staff who receive payments either by mail or direct payment.
Verifies patient eligibility with health-plans, reviews rejected claims and makes adjustment to patient accounts as necessary.
Attends all departmental and organizational meetings as required.
Answer patient questions regarding statements in person and through phone calls.
Pro! vides general billing assistance within the department as applicable.
Arranges and attends meetings and conferences as necessary. Assists as needed with agenda and materials preparation.
Provides additional support to the Patient Accounts / Billing and backup assistance for the staff as needed.
Ensures that assigned insurances are managed to promote proper financial reimbursement prior to timely filing deadlines.
Assists in overseeing payor issues including but not limited to, working with each payor to improve collections and reduce accounts receivable days, reconciling remittance statements and updating payor information
Must demonstrate and apply critical thinking skills when reviewing patient accounts to ensure correct balancing for patient statements to be sent.
Ability to identify, utilize critical thinking skills and to assist in resolving patient billing complaints.
Assists in completion of month end close activities, including but not li! mited to, ensuring that charges and payments are posted to enable compl! etion of month end reporting.
Responsible for review and maintenance of daily patient account transactions with a high level of speed and accuracy.
Assists in reviewing rejected claims and make adjustments to patient accounts as necessary to ensure maximum reimbursement.
Assists with accurate, efficient and timely payment processing and adjustments, from insurance companies, as well as accurate patient payment posting. Will assist in resolving payment transaction discrepancies as necessary, and to report to the Patient Accounts Manager to resolve any system discrepancies.
Completes follow-up activities for unpaid claims, timely, effectively and efficiently within timely filing limits for various insurance companies. Will document reasons for denials that cannot be re-billed, and communicates such information to Patient Accounts Manager and/or Chief Financial Officer.
Comprehensive knowledge of CPT, ICD-9 and HCPCs coding books.
Complies with external! and internal organizational policies, State and Federal guidelines, as well as third party liability contract information to assure consistent quality billing and coding.
Comprehensive knowledge to utilize appropriate third party liability (TPL) and government websites (i.e. CHAMPS, C-SNAP, WebDenis, HMO Medicaid websites that FHC participates with) to ensure billing and coding compliance.
Credentialing & Billing Specialist
Education and/or Experience
Associates Degree in Business or in a Healthcare related discipline, or equivalent education required. Bachelors degree preferred. In addition, requires a minimum of two years of credentialing experience in a healthcare environment. CMSC and/or CPCS Certification by the National Association Medical Staff Services preferred. Affiliation with the National Association Medical Staff Services and the State Association Medical Staff Services strongly encouraged. Willingness to maintain a flexible work sche! dule as needed. Working knowledge of CHAMPS and C-SNAP are required and! a working knowledge of ICD-9, HCPCS, CPT is preferred. Ability to work effectively and efficiently under tight deadlines, high volumes and multiple interruptions.
Salary & Benefits
Full time and salaried employees enjoy a highly competitive salary and full benefits including: medical, dental and vision benefits, 403B retirement savings plan, supplemental life insurance, short and long term disability and a flexible spending account.
Family Health Center's mission is to provide excellent health care to anyone who walks through our doors, regardless of their income level or insurance benefits. Our board-certified physicians are specialists in family medicine, internal medicine, pediatrics, obstetrics/gynecology and dental. Our mid-level providers allow us to accommodate acute and same-day appointments to avoid overuse of emergency rooms. We are passionate about our work here and invite you to visit us any time to see for yourself the powerful contributi! ons of the Family Health Center at work in our community. With 7 locations in Kalamazoo and its surrounding cities, Family Health Center is one of the fastest growing primary care organizations in Southwest Michigan.
Our Community
Family Health Center is located in beautiful Kalamazoo in Southwest Michigan, about 2 hours from Chicago. This community effortlessly combines energy and innovation with friendliness and an easy-going attitude. Kalamazoo is home to the nationally recognized Western Michigan University, several colleges and a variety of cultural institutions. A vibrant Art Deco downtown sets the stage for quality dining, unique shops and galleries, and live entertainment. In Kalamazoo, you're never far from lakes and other outdoor recreation, festivals and world-class attractions.
The schools in Kalamazoo are host to the Kalamazoo Promise. A program recognized by the president of the United States, this is the only scholarship of its kind. Kalamazoo res! ident graduates of the Kalamazoo Public Schools may receive up to 100 p! ercent of their college tuition and mandatory fees for four years at Michigan's public universities and community colleges.
Credentialing & Billing Specialist
- .
If you were eligible to this vacancy, please email us your resume, with salary requirements and a resume to Family Health Center.
If you interested on this vacancy just click on the Apply button, you will be redirected to the official website
This vacancy starts available on: Sat, 20 Jul 2013 09:52:35 GMT