Billing and Credentialing Specialist

• Supervises and coordinates Clinical staff credentialing activities; responsible for providing varied clerical support for the Clinical Staff Office, and other duties that support various Clinical Staff Office activities. Supports the Management and serves as effective liaison between the Clinical Staff and Clinical Center Administration; provides insight into State and Federal Regulatory Agencies, accreditation compliance and other critical matters that affect the healthcare environment.

Other Information

Required Job Qualifications:

• Bachelor’s Degree or equivalent from an accredited college or 2 years credentialing experience in medical/clinical staff services.
• Certified by the National Association Medical Staff Services (NAMSS) or willing to achieve certification within 3 three years.

Responsibilities

• Schedule daily or weekly calls with Billing and Credentialling Company
• Oversees, initiates, administers, verifies, compiles, manages and maintains confidential research required for credentialing of initial applicants (Physicians, Advanced Practitioners etc)
• Oversees entire billing operations and analyze aging A/R to keep it within industry standards.
• Point of contact for billing team to navigate through clinical team as well as providers, prior auth dept and insurances
• Ensuring patient balances are addressed proactively and manage any such patient complaints escalated by billing team
• Process according to established legal, State and Federal agency, State licensing board standards.
• Prepares and reports all research and forwards to Chief Clinical Officer.
• Coordinates tracks and monitors flow of information to ensure the timely processing and notification of providers
• Manages, coordinates, monitors, and maintains effective credentialing processes intended to appropriately credential physicians and advanced practice providers for reappointment and/or clinical privileges at local hospitals as needed.
• Provides mentoring, training and direction of credentialing duties and responsibilities, as well as processes to credentials coordinator to ensure efficient utilization and turn-around time. Acts as a resource to credentialing coordinator.
• Oversight of tracking compliance of credentialing expirable and annual mandates.
• Establishes timeline and trends benchmarks for timely claims submission to insurances
• Leads preparations for various special events, social events and physician orientations.
• Develops and revises credentialing forms as necessary.
• Senior point person for external/internal accreditation requests to provide provider data

Summary

As a Billing and Credentialing Specialist, you will be integral to the financial and operational success of our healthcare organization. Reporting to the Billing Manager, your role involves ensuring accurate billing processes and compliance with NCQA standards. Your core skills in medical office experience and medical terminology will be essential in managing claims and credentialing providers. Additionally, your premium skills in managed care will enhance our relationships with insurance partners. Join our team to contribute to efficient billing practices and uphold the highest standards of patient care.

Job Type: Full-time

Pay: Up to $80,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday
• No weekends

Experience:

• Microsoft Office: 3 years (Preferred)
• Microsoft Word: 3 years (Preferred)

Ability to Commute:

• Las Vegas, NV 89113 (Required)

Ability to Relocate:

• Las Vegas, NV 89113: Relocate before starting work (Required)

Work Location: In person

Salary : $80,000