What are the responsibilities and job description for the Provider Credentialing/Accounts Receivable Representative position at Vanguard Group Staffing, Inc.?
A large, multi-specialty surgical group in Westchester is seeking an Accounts Receivable / Credentialing Representative on a temp-to-hire, or direct hire basis. This position will be fully onsite, Monday through Friday, 9am - 5pm. Our client is seeking candidates who have experience with Provider Credentialing and will provide training on their Accounts Receivable functions.
Experience, qualification, and soft skills, have you got everything required to succeed in this opportunity Find out below.
RESPONSIBILITIES :
Serving as a liaison between practice, credentialing company, and new / current providers; obtaining all necessary information to complete insurance credentialing, current hospital credentialing / privileges and re-credentialing status, ensure applicable fees and permits are issued and kept current, submit current malpractice liability certificates
Organize, file, maintain detailed records of all credentialing and receivables information in designated drives, EMR, and / or other systems
Analyze EOB information, co-pays, deductibles, co-insurance, contractual adjustments, underpayments and denial reasons.
Review, follow up and respond to inquiries via email, phone or incoming correspondence in a timely manner to resolve outstanding balances, patient complaints or questions regarding the billing process
Review patient account balances to ensure all patient payment are applied appropriately.
REQUIREMENTS :
Experience obtaining the initial status of medical claims by calling insurance carriers and / or checking online web portals
Experience with follow up via carrier communication through phone / online web portals to resolve issues and ensure claims are paid timely and appropriately
Experience resolving denials and submitting appeals : Identify and resolve denials and payment variances and act to resolve issues through claims reprocessing, claim corrections, and / or drafting and submitting reconsiderations / appeals
Proficiency in Microsoft Office Suite including Outlook, Word, Excel and OneDrive
Knowledge of CPT / ICD10, medical terminology
Familiarity with EMR systems preferably Centricity, ModMed or equivalent
High level of customer service & interpersonal skills to work effectively with insurance companies, patients, physicians, and other team members in the practice
high level of accuracy and attention to detail, well-organized, self-motivated, and ability to multi-task while working in a fast-paced environment to meet various deadlines
Abide by HIPAA and any state and federal laws to remain complaint in accordance with practice policies and procedures
Ability to read and interpret explanations of benefits, insurance denials, partials payments, adjustments, and recoupments
