What are the responsibilities and job description for the Credentialing Coordinator position at Synergy Services?
Position: Credentialing Coordinator
Program: Family Care
Status: PRN, Hourly
Description:
This position will coordinate provider credentialing and insurance panel membership. Will assist Billing Coordinator as needed with various billing activities.
Will assist all agency therapists with the following:
- Coordinate provider credentialing and insurance panel membership.
As needed, will assist Billing Coordinator with the following:
- Coordinate service eligibility determination,
- Coordinate insurance verification and authorization,
- Coordinate insurance billing and record-keeping
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:
Coordinate and maintain records of provider credentials needed for billing.
Foster Synergy becoming a member of insurance networks and panels.
When needed, will assist with the following:
Client eligibility screening and determination as part of admission procedures.
Provide client sliding fee scale determination and/or verification of insurance.
Provide insurance billing and client billing, and facilitate information flow between treatment providers and insurance companies.
Assist with other billing related projects such as researching rejected claims.
Provide related documentation and data entry as needed for admission eligibility, financial record-keeping, insurance billing, and other information related to case records management.
Provide assistance in medical records billing or invoicing and justifying outstanding accounts when cases close.
Performs billable services audits.
Program Development: Participates in program planning and problem solving, attends administrative meetings, consults and collaborates with Lead Therapists and Clinical Director to monitor and improve the admission process, billing, and records management policies and procedures.
Training: Participates in professional development and training as needed to maintain proficiency in client and third party billing standards.
Participation in Performance and Quality Improvement activity is required by each employee.
Performs other duties as assigned.
SUPERVISORY RESPONSIBILITIES
This job has no supervisory responsibilities.
QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION and/or EXPERIENCE
Bachelor's degree (B. A.) from four-year college or university; or one to two years related experience and/or training; or equivalent combination of education and experience.
LANGUAGE SKILLS
Ability to read, analyze, and interpret common scientific and technical journals, and clinically related reports and documents. Ability to respond to common inquiries or complaints form customers, and regulatory agencies. Ability to write for documentation and program planning purposes. Ability to present to groups and classes for training purposes.
MATHEMATICAL SKILLS
Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
REASONING ABILITY
Ability to apply principles of logical or scientific thinking to a wide range of intellectual and practical problems. Ability to deal with a variety of abstract and concrete variables.
OTHER SKILLS AND ABILITIES
The employee in this position must have the ability to type and use computer software, including Windows, Word for Windows, EXCEL and Access. The employee in this position must be familiar with counseling and therapy terminology.
PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee is occasionally required to stand, walk, and sit. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, and depth perception.
While performing the duties of this job, the employee is regularly required to sit and talk or hear.
WORK ENVIRONMENT
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.The noise level in the work environment is usually moderate.
Non-Discrimination:
Synergy Services is an EEO employer. We firmly support the principle and philosophy of equal employment for all individuals, regardless of age, race/ethnicity, religious creed, ancestry, color, sex, disability (including pregnancy), national origin, marital status, political belief, sexual orientation, gender identity, gender expression, genetic testing and screening information, covered veteran status or any other protected category pursuant to applicable federal, state or local laws.
Benefits:
All full-time positions are eligible for generous benefit package including medical, dental, vision, life and disability insurance, PTO, paid holidays and a 401K Plan with Employer Match. Some regular part-time positions are eligible for partial benefits.
