Non-Profit Credentialing/Billing Specialist

As part of Arundel Lodge's commitment to the Recovery Model, the Credentialing Specialist/Billing Clerk will practice in a manner that emphasizes hope, self-determination, empowerment, and respect for Persons Served, using strength-based, non-stigmatizing language.

Qualifications:

• High School diploma required; at least 4 years of relevant experience in credentialing, billing, or data entry; college degree preferred.
• Strong understanding of credentialing processes and relevant healthcare regulations.
• Experience with Electronic Health Record (EHR) systems, preferably Credible.
• Proficient in Microsoft Office Suite (Word, Excel, Outlook) and ability to learn new software programs quickly.
• Strong organizational skills, attention to detail, and the ability to manage multiple tasks effectively.
• Excellent communication skills, both written and verbal, with a customer service-oriented approach.
• Ability to work collaboratively with a team and independently when necessary.

Credentialing Specialist Responsibilities:

• Participate in the new hire process by reviewing and verifying healthcare providers' licenses, certifications, and other required documentation to ensure they are current and accurate.
• Maintain the CAQH provider database, including education, training, employment history, and credentialing status.
• Work closely with the Billing Supervisor to prepare and submit credentialing applications to payers and health plans for employed and contracted healthcare providers.
• Track and follow up on application statuses to ensure successful completion.
• Manage the re-credentialing process for Arundel Lodge and its healthcare providers.
• Maintain Arundel Lodge's Maryland Medicaid application (EPrep) and Medicare application (PECOS/NPPES), along with all other required licenses and applications for appropriate claim processing.
• Stay updated on regulatory and legal changes to ensure compliance with relevant healthcare laws and credentialing standards.

Billing Clerk Responsibilities:

• Track, request, and enter authorizations for Medical Assistance persons served (Outpatient Mental Health Center, Residential, Supported Employment, Substance Abuse) through the Carelon provider portal.
• Follow up with appropriate staff on authorization denials or requests for additional information.
• Provide backup support for billing or data entry tasks as needed.
• Enter insurance information for new residential persons served.
• Verify Medical Assistance status for residential persons served and follow up as needed.
• Receive and record customer payments, verify accuracy (cash, check, credit card), and post them to appropriate accounts.
• Issue monthly statements to persons served and respond to questions and complaints regarding bills.