Credentialing & Billing Support Specialist

ViaroHealth- Credentialing & Billing/Coding Support Specialist

$22.00-$28.00/Hour, Based on experience

Responsibility for medical billing and coding submitted to commercial and government health insurance plans for services provided by ViaroHealth Maintenance of external network contracting/credentialing and internal credentialing of Viaro clinic and providers with all required insurance companies and maintaining the internal provider credentialing program.

The position will be paid competitively with opportunities for additional benefits. Success will be measured through favorable reviews and the ability to meet stated objectives.

Job Requirements

Insurance Network Credentialing Responsibilities

• Maintain and monitor the effectiveness of insurance network credentialing as described
• Follow-up on clinic, staff and provider credentialing, maintaining a system that ensures completion of contracting/credentialing documents; work to identify and resolve any issues related to contracting or credentialing
• Credential the clinic and providers with insurance companies based on provider type and eligibility and maintain provider files including information needed to complete the required governmental and commercial payer credentialing applications
• Collect required release, authorization, and attestation forms from providers, as necessary

Medical Billing and Coding Responsibilities

• Maintain and monitor the effectiveness of the billing and coding systems
• Review Clinical Documentation when necessary to extract and convert diagnoses, treatments, and procedures into universal medical alphanumeric codes
• Double-check codes for correctness; ensuring they meet federal regulations and insurance standards
• Work with providers to clarify diagnoses or procedures for accurate coding and ensure the security and confidentiality of patient information as mandated by HIPAA
• Stay informed about coding guidelines and changes in the medical field through continuing education
• Assist in internal or external audits by providing necessary coding documentation or clarifications

Internal Credentialing Responsibilities

• Maintain provider internal credentialing, including forms and document storage
• Distribute initial credentialing forms to providers based upon determined provider level and requirements
• Conduct thorough review of provider information and ensure accuracy and completion of providers’ initial credentialing forms
• Maintain current provider information, records and credentials
• Conduct required background checks and exclusion list checks based on provider type and role
• Conduct recredentialing processes in accordance with state and federal standards and remain in compliance

Internal Licensing Responsibilities

• Maintain internal licensing program, including workflow, forms, and document storage
• Apply for and renew annually all provider licenses and certifications ie, professional, DEA controlled substance
• Complete and submit multiple state license applications on behalf of providers who require it

Knowledge, Skills and Abilities

• Proficiency with medical terminology, medical billing software and insurance billing processes
• Ability to work with electronic health record (EHR) systems, coding software
• Understanding of primary code classifications: ICD-10/11-CM, ICD-10/11-PCS, CPT and HCPCS
• Knowledge of ethical debt collection practices and insurance guidelines
• Basic accounting and bookkeeping practices
• Knowledge of medical terminology related to diseases, treatments, anatomy, and physiology

Education and Experience

• Associate degree or similar combination of experience and education will be considered
• 5 years medical billing and institutional billing and accounts receivable
• Certified Professional Coder preferred
• Credentialing Certification preferred

BENEFITS

• FREE primary care clinic for you and your dependents
• Employee wellness programs, most offered to you at NO cost, including a fitness center membership worth $467 a year
• We pay 80% of medical benefits for FT eligible employees, and we have FSA and Retirement Savings options, PTO & Holiday Pay