What are the responsibilities and job description for the Credentialing Specialist position at BrightSpire Health?
Mental Health Billing and Credentialing Specialist
Join a collaborative and quickly growing Oregon mental health group practice that provides the highest standards of clinical care. BrightSpire Health is seeking a billing specialist, a credentialing specialist, or someone who is skilled in both for a part-time position with potential of full-time. This is an hourly position to start with competitive benefits and compensation commiserate to experience and includes excellent references. Position to start immediately.
Focus is on individual(s) that are committed to ethical billing and have expert knowledge in mental health billing and/or provider credentialing. Building strong relationships with payers and offering compassionate communication and financial efficacy with clients and providers is a must. (Must live in Oregon)
Submit resume to: admin@brightspirehealth.com
Billing Specialist Responsibilities:
Insurance eligibility and verification
Posting daily charges
Submitting claims and appeals
Maintain correspondence with carriers
Processing remittances
Insurance Aging reports
Posting Insurance payments
Patient interaction regarding balances and insurance questions
Review and resolve billing edits, and knowledge of Valant (EHR) and WayStar (clearinghouse) a plus
Timely Data Entry and excellent organizational skills
Billing Specialist Qualifications: (Start out part-time, 20 hours/week 30/ week if doing both billing and credentialing. Potential of full time) Hybrid, and must be willing to commute to Beaverton, Oregon.
- Must be punctual regarding claim submissions, processing remittance, posting remits, posting daily charges, insurance eligibility and verification
- Experience with mental health claims submission
- Working knowledge of OS Office, Excel and Outlook
- Working knowledge of Valant electronic health record, and WayStar clearinghouse a BIG plus
- Start out part time (10 hours a week, 20 if both billing and credentialing roles) with potential towards full time
- Commitment to excellent and compassionate communication skills with clients and providers
- Must have at least 3 years of operational billing/collecting experience in a medical setting
- Must know ICD10, CPT and modifiers
- Skilled in pin-pointing problem accounts and determining a plan of action
- Professional communication skills, prompt responsiveness and excellent, organized, and clear writing skills
AND/OR Credentialing Specialist Responsibilities:
-Conduct initial credentialing application reviews and summarize results for recredentialing committee
-Ensure compliance with National Committee for Quality Assurance (NCQA) credentialing standards
-Maintain provider database and ensure the timely and accurate submission of data and reporting for provider correspondence, the Plan's Information Services Department, Management Service Organization (MSO), and other appropriate usage
-Act as liaison between the Plan and providers regarding credentialing and re-credentialing activities in consultation with the recredentialing committee
-Maintain provider credentialing files in compliance with regulatory standards
-Maintain current knowledge of regulatory requirements and standards with regard to credentialing
-Schedule biweekly Credentialing Sub-committee meetings
-Communicate changes to credentialed provider network and to appropriate departments/staff
-Coordinates provider credentialing process to increase efficiency and ensures that payer (e.g.Cigna) credentialing deadlines are met
-Support providers in establishing, updating and maintaining CAQH
-Excellent organization and regular timely tracking, management and submission of payer applications
-Confidence in use of a credentialing tracking system/application
Credentialing Specialist Qualifications: (10 hours/week to start) Hybrid, and must be willing to commute to Beaverton, Oregon
- An Associates degree or higher education
- Certification in credentialing a plus (CPCS, etc.)
- Experience with Valant and WayStar a plus
- Conduct eligibility verifications
- Establishing and maintaining a system for timely processing of credentialing and re-credentialing files in accordance with the company, CMS and NCQA policies
- Ensuring that providers/HDOs on the company's participating panel are in compliance with the company policies and NCQA and state and federal regulatory standards
- Maintaining current knowledge of NCQA, State and Federal requirements
- Performing data entry in and maintaining currency of the database for tracking practitioner / HDO credentialing and re-credentialing information
- Initiating and conducting primary source verification of provider credentials
Submit resume to: admin@brightspirehealth.com
Job Types: Full-time, Part-time
Schedule:
- 4 hour shift
- 8 hour shift
- Day shift
- Monday to Friday
Work Location: Hybrid remote in Beaverton, OR 97005
