Billing/Credentialing Specialist

Job Description

Salary:

Under the direct supervision of the Claims Manager, this position is responsible for credentialing, re-credentialing, and privileging processes for all medical, dental, and behavioral health providers who provide patient care at Cabarrus Rowan Community Health Centers, Inc. This role is responsible for supporting our providers who are credentialed, appointed, and privileged with health plans, hospitals, and patient care facilities. Maintain up-to-date data for each provider to ensure timely renewal of licenses and certifications. In addition, this position will also process medical and dental claims, ensure proper billing, and assist in correction of rejected claims. While this role report directly to the Claims Manager, he/she will work collaborative with the Dental Operations Manager to ensure full credentialing, re-credentialing, and privileging of all dental providers.

Key Responsibilities

• Responsible for all aspects of the credentialing, re-credentialing, verification, and privileging processes for all medical providers who provide patient care at and for CRCHC, which includes Dental, Behavioral Health as well as specialty providers. 2. Responsible for ensuring providers are credentialed, appointed, and privileged with health plans, hospitals, and patient care facilities. 3. Maintain up-to-date data for each provider on the Credentialing Grid and ensure timely renewal of licenses and certifications. 4. Coordinates and provides support in the processing and verifying of credential information for providers in accordance with HRSA policies.
• Works to ensure that valid and timely information is provided for practitioner credentialing decisions. 6. Monitors information collection and analyzes data received to ensure accuracy. 7. Maintain corporate provider contract files. 8. Sets up and maintains provider information in online credentialing databases and systems such as CAQH Practice Manager. 9. Maintains Providers credentialing status with commercial insurance, Medicaid, and Medicare; performs maintenance of practices credentialing status as assigned by the Claims Manager or Dental Operations Manager. 10. Conduct follow-up activities as necessary. 11. Upon completion of verification, ensures up-to-date hard copy and file integrity, notifying supervisor of any outstanding information or clarification required. 12. Assists with verification of providers by using various web sites that are required by HRSA for a FQHC facility. 13. Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers. 14. Clerical tasks include filing reports, typing statements, typing letters, faxing applications, answering phones, making copies, scanning documents, and emailing. 15. Maintains confidentiality of provider and organization information agencies and health plans to ensure necessary flow of information to maintain credentialing. 16. Assists with reviewing, updating, developing credentialing policies, procedures, and processes in coordination with senior management team. 17. Conducts onboarding activities of all new providers as it relates to enrolling providers in the organizations in-network listing of payers. 18. Perform claim resolution on denied insurance claims for all service lines. 19. Post charges and payments to correct accounts. 20. Follow up on unpaid claims and resolve discrepancies by telephone, fax or email communication. 21. Investigate and appeal claims that were denied, following up and completing appeals in a timely manner. 22. Provides special project support assigned by Claims Manager or Dental Operations Manager. 23. Assist patients with dental billing questions via Dentrix (training will be provided by Dental Operations Manager). 24. Complete Dental requests for all CRCHC locations in terms of prior authorizations and referrals. 25. Create patient claim, collect payment, and document payments in electronic health records. 26. Assisting in researching and resolving claim denials, patient refunds, and collections follow-up. 27. Accurate and timely review, reconcile, and hand post patient insurance payments, both by EFT and check. 28. Performs all other duties assigned by management.