Revenue/Credentialing Specialist

Revenue/Credentialing Specialist

Dr. Arenia C. Mallory Community Health Center is actively recruiting for a Revenue/Credentialing Specialist to assist our Front Desk/Receptionist with providing and monitoring private pay, Medicaid, Medicare and Insurance billing and payment processing and the accounts receivable system. The Revenue/Credentialing Specialist works with Medicaid, Medicare, and Insurance claims, post payments to accounts and performs various other tasks that relates to billing and collections.

EDUCATION/EXPERIENCE:

AA Degree from a Business or Technical school with one year experience or High school diploma or GED with 3 years of related and/or training or equivalent combination of education and experience.

ESSENTIAL DUTIES/RESPONSIBILITIES:

• Gathers Medicaid, Medicare, and insurance billing information by reviewing patient medical records and checking for completeness.
• Ensures payments by verifying accuracy of Medicaid, Medicare, and insurance coding.
• Bills Medicaid, Medicare, and Insurance carrier by inputting billing information to database and initiating electronic transmissions.
• Resolves disputed claims by gathering, verifying, and providing additional information; following-up on claims.
• Resolves discrepancies by examining and evaluating data and selecting corrective steps.
• Adjusts patient bills by reviewing remittance advice and consulting with receptionist.
• Prepares monthly reports of Medicaid, Medicare, and Insurance billing by summarizing billings, adjustments, and revenues received.
• Updates job knowledge by participating in educational opportunities; reading professional publications; keeping current on Medicaid, Medicare, Insurance billing and reimbursement procedures.
• Serves and protects the organization by adhering to professional standards, insurance policies and procedures, federal, state, and local requirements.
• Demonstrate the ability to write and balance deposit slips correctly.
• File and key secondary Insurance claims once primary insurance Explanation of Benefits is received for Medicaid, Medicare, and Insurance.
• Demonstrate the ability to file insurance forms within appropriate time frame.
• Correct invalid diagnoses, CPT codes and resubmit all the necessary claims and documentation in a timely manner.
• Able to contact insurance companies for status on claims as necessary.
• Demonstrate the ability to communicate with patients concerning accounts.
• Report to Supervisor concerning problems with insurance and patient accounts balances.
• Effective collect data necessary for preparing proper Financial Reports.
• Perform other necessary duties as required by Mallory CHC to meet the goal of providing primary health care.

BENEFITS PACKAGE INCLUDES:

• Health (Medical) Insurance
• Dental Insurance
• Vision Insurance
• Basic Life and AD&D Insurance
• Ancillary Benefits (Accident, Cancer, Disability, Critical Illness, Whole Life, Term Life, and Hospital Confinement)
• Holiday Pay
• Vacation and Sick Leave Package
• Retirement Plan
• Professional Liability Insurance Coverage
• Student Loan Forgiveness Program
• Incentive Production Bonus
• Paid Professional Membership Fee Allowance
• Continuing Education Leave and Training Education Allowance
• Guaranteed Work Schedule: Mon-Thurs 8am to 5pm and Fri 8am-2pm

In addition, your compensation package includes the following - Health insurance paid up to 85%, 403B Retirement Plan, Free Basic Life and AD&D Insurance, MCHC Employee Patient Privileges, Free Employee Assistance Program: "WorkLife Matter" Access (Telehealth), Legal Assistance Services, and Identity Protective Monitoring Services and more.

Job Type: Full-Time

Salary Range: Negotiable Commensurate with experience and qualifications