Medical Billing and Credentialing Specialist

Essential Functions, Duties, and Responsibilities

Main Responsibilities

• Directly responsible for processing all claims in a timely fashion to prevent timely filing denials.
• Resolve issues and conflicts that arise between insurances and provided information.
• Resolve insurance denials as they arise and research independently to make corrections quickly and accurately.
• Provide excellent customer service to patients who call into the office to inquire about billing procedure, insurance coverage, and current balances.
• Work with denials team to ensure all claims are reworked and reprocessed quickly. Ensure that common denials are reported to Revenue Cycle manager for continued staff training and correction.
• Maintain and track provider credentials to ensure timely contracting of providers

Administrative Responsibilities

• Follows all communication protocols for contacting manager on a regular basis.
• Creates and reviews reports and other operational documents to process and verify insurance information.
• In partnership with manager, identifies performance and process improvement opportunities to create operational efficiencies, leading to an improved work environment and minimal errors.
• Participates in development programs and services that address specific aspects of the processes within their service area.

Functional Responsibilities

• Follow monitoring and tracking systems to ensure timely and accurate processing of information.
• Ensure pending claims are processed in a timeline set by KPI goals and patient volume.
• Providing regular updates/reports to manager.
• Collaborate with manager to identify process improvements and staff education/training needs to ensure timely and accurate billing processes occur across the patient journey, resulting in timely and accurate filing of claims.
• Ensure current insurance information is being used for all patients while adhering to all organizational billing policies and procedures.

Additional Responsibilities

• Participate in ongoing professional development as provided by the company, and self-directed learning.
• Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency.
• Maintain confidentiality by safeguarding ePHI and demonstrating HIPAA compliance to our patients.
• Ensure that HIPAA privacy policies are clearly understood and followed.
• Comply with all Sierra Podiatry Corporation policies and procedures.

Punctual and regular attendance is an essential responsibility of each employee

at SPC. Employees are expected to report to work as scheduled, on time, and

prepared to start working. Employees also are expected to remain at work for

their entire work schedule. Late arrival, early departure, or other absences from

scheduled hours are disruptive and must be avoided.

• The list of job duties and requirements is not all-inclusive. Management, at its discretion, may assign additional duties.

Job Type: Full-time

Pay: $20.00 - $30.00 per hour

Benefits:

• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Work Location: In person

Salary : $20 - $30