North Mississippi Primary Health Care
Billing and Credentialing Specialist
Job Description
SUMMARY:
The Billing and Credentialing Specialist , a key position in the Revenue Cycle, manages the claims process, including accurate and timely claim creation, follow-up and correspondence with providers, insurance inquiries/correspondence. The incumbent will assist in the clarification and development of process improvements and inquiries, assure payments related to patient services from all sources are recorded and reconciled timely in order to maximize revenues. Other important duties include credentialing, enrollment processing, and reporting.
Responsibilities:
Billing and Claims
- Prepares and submits clean claims to third party payers either electronically or by paper.
- Maintains relationship with clearinghouse, including appropriate follow-up with support issues.
- Coordinate the process of patient eligibility through various third party sources.
- Manage monthly statement process, to include reviewing statements before electronically submitting.
- Post all insurance remittance advices & patient payments daily, daily deposits and running credit cards daily.
- Handles patient inquiries and answers questions from clerical staff and insurance companies.
- Identifies and resolves patient billing problems.
- Denial and insurance follow-up management.
- Issues adjusted, corrected, and/or re-billed claims to third party payers.
- Posts adjustments, transfer of responsibility and refunds, as necessary.
- Assure coding is compliant and up to date.
- Reviews accounts and makes recommendations to the Chief Financial Officer regarding non collectible accounts.
- Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
Credentialing
- Maintain up to date credentials for each licensed provider, including verification through primary and secondary sources.
- Record and relay credentialing information to relevant personal
- Maintain accurate records for provider licensure/ certification renewals.
- Coordinate provider enrollments in all commercial, federal and state insurance programs.
Job Requirements:
- Knowledge of medical billing / collection practices required
- Strong keyboard skills.
- Works well in environment with firm deadlines; results oriented.
- Perform multiple tasks effectively.
- Able to work both independently and as part of a team.
- Strong analytical skills required.
- Capable of making timely, independent decisions.
Experience:
- Previous medical billing experience including knowledge of billing related reporting; 3-5 years’ experience in healthcare billing & collection practices, preferably with an FQHC,
- Experience working with medical payers including Medicare, Medicaid, and commercial insurance
- Working knowledge of medical billing systems
- Experience with Medicaid’s State Eligibility System,
- Working knowledge of CPT & ICD-10 coding systems; Coding certification preferred
- An Associate Degree from an accredited university with credentials in billing/coding preferred
- Excellent organizational skills
Physical and Cognitive Requirements
- Requires full range of body motion including manual finger dexterity and eye-hand coordination.
- Able to lift 25 pounds, with or without reasonable accommodation.
North Mississippi Primary Health Care, Inc. is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.