Job Description :

The Credentialing and Insurance Follow-Up Specialist will be responsible for

administrative billing support including the following : Fluent English speaking and

written communication skills, good time management skills, and professional dress, speech, and

behavior are all required for this position.

The following is a representative list of the duties and responsibilities associated with this position :

Enroll and credential providers (e.g.

physicians, facilities, physician

assistants, nurse practitioners, etc.) with insurance companies

Clearly and effectively communicate with providers, practices and insurance

Document credentialing and network status and communicate with

practices to ensure patients are seen by credentialed and in network

providers

Follow up with clients and insurances for timely credentialing process(es)

Review, and update, health plan directories, agencies, and other appropriate

entities for current and accurate provider information

Maintain access to insurance and government payer portals and share with

business contacts as needed

Knowledge of provider credentialing / accreditation / insurance regulations,

policies, guidelines, and standards

Work with RCM team to determine the root cause for credentialing and

payer network related denials from insurance carriers and develop solutions

to resolve

Support payer contracting, escalations, and contract negotiation strategy as

needed

Support payer setup in the PM / EMR system and clearinghouse for billing

Perform other duties as assigned

Submit Primary / Secondary Insurance and Follow-up on same.

Place Outbound Calls To Insurance for Status of Outstanding Claims.

Analyze Remittance / Explanation of Benefits.

Determine Correct Payment According To Hospital / Payer Contract.

Determine Patient Responsibility.

Submit Adjustment Claims, Submit Appeals for Underpayment and / or

Denials.

Verify Insurance Coverage, Contact Guarantor Regarding Insurance

Discrepancies.

Follow guidelines for MSPQ (Medicare Secondary Payer Questionnaire)

Processing.

Ability to work flexible hours as determined by management.

Strong communication, documentation, follow up, analytical, and computer

skill sets.

Familiarity with the Hospital’s Epic System A .

Ability to accurately update

patient accounts, update

Insurance information, initiate insurance billing,

Performs other job-related duties, as required and assigned.

Qualifications :

High school degree or equivalent required.

Bachelor’s degree in business, healthcare related

field preferred or equivalent experience

Experience in credentialing or other medical experience relevant to insurance carrier

credentialing

Excellent organizational skills

Strong analytic and problem-solving abilities

Excellent verbal and written communication skills

Able to maintain confidentiality.

Experience with Microsoft Office-Excel, Word, PowerPoint and the ability to master programs

needed for position

Must be able to work independently

Note :

We do work with the unemployment office.

requirements.

Last updated : 2024-07-11