BILLLING AND CREDENTIALING SPECIALIST

BILLING AND CREDENTIALING SPECIALIST POSITION SUMMARY

Function as a subject matter expert in medical practice revenue cycle, to include review of coding and processing of claims, provider credentialing and insurance enrollments. Supports the companys core values by exhibiting integrity, trust, respect, compassion, quality, teamwork, accountability, communication, and a commitment to the community.

WHY SHOULD YOU APPLY?

• Growth and Advancement Opportunities
• Company Sponsored Events
• Employee Engagement Committees
• WCHC offers a compressive benefit package including:
  1. Medical, Dental, and Vision insurance - Full Time
  2. Health Reimbursement Arrangement - Full Time
  3. Employer paid Life and AD&D and Disability insurance - Full Time
  4. Education reimbursement - Full Time
  5. 401K with employer match - Full Time and Part Time
  6. Generous Paid Time Off and Volunteer time - Full Time and Part time
  7. Paid Holidays - Full Time And Part Time

BILLING AND CREDENTIALING SPECIALIST PRIMARY ACCOUNTABILITIES

• Ensure timely and accurate submission of all claims including following up with third party payers
• Daily review of rejected/denied claims; making edits or appeals to resolve errors to ensure expedited processing.
• Management and reconciliation of daily Time of Service (TOS) batches/deposits from all sites.
• Enter payments and denials to patient accounts. Contacts patients regarding outstanding balances and follows up on previous payment commitments.
• Monitor and manage the collection process, patient account aging, and adjustment/bad debt reporting while keeping management informed of billing, credentialing and collection issues
• Assist in the analysis and reporting of Accounts Receivable. Utilize systems to collect, analyze, and report information to management in a timely and accurate manner.
• Audits credit balances and refunds payers and/or patients when overpayments occur.
• Answers patient billing questions verbally and/or in writing.
• Perform other related duties as needed.
• Ability to comply with and adhere to all regulatory compliance areas, policies and procedures.
• Ensure effective, positive relationships within and among other department staff, as well as other functional areas within the organization.
• Develop and ensure favorable working relationships with vendors, third party payer resources, and related external resources.
• Uphold and consistently represent the values and mission of the organization at all times.

BILLING AND CREDENTIALING SPECIALIST ESSENTIAL FUNCTIONS/ KEY COMPETENCIES

• Demonstrate a high level of problem solving skills. Demonstrate the ability to make critical decisions supported by data.
• Proficiency in Word and Excel
• Excellent attention to detail and able to prioritize tasks.
• Demonstrate interpersonal savvy and influence skills with the organizations leaders, staff, regulators, vendors, auditors and related external entities.
• Ability to routinely and creatively use and understand technology necessary to collect, retain, analyze and report financial information.
• Ability to regularly and effectively communicate throughout all levels within the organization in written, verbal, and presentation format.

BILLING AND CREDENTIALING SPECIALIST EXPECTED HOURS OF WORK

• Days and hours of work will be scheduled Monday through Friday, between 8:00 a.m. and 5 p.m.

BILLING AND CREDENTIALING SPECIALIST POSITION REQUIREMENTS

• High School Diploma/GED required Experience
• Demonstrated experience and significant knowledge of medical coding, billing and credentialing, 3-5 years medical billing experience, preferred.
• Significant computer and Electronic Health Record (EHR) systems knowledge required. Knowledge of eClinicalWorks is preferred.
• Federally Qualified Health Center billing experience is preferred.
• Significant knowledge of federal and state billing regulations and credentialing requirements.
• Demonstrated analytical skills and aptitude for solving problems.
• Demonstrated high level of communication and customer service skills Physical/Environmental 2
• Ability to interact with computer screen. (Visual acuity required).
• Must have manual dexterity for use of keyboard. Ability to remain stationary for periods of up to four hours. Ability to communicate via phone, mail and in person to resolve disputes, solve problems, etc.
• Cognitive skills to analyze, calculate, problem solve issues related to the billing, credentialing, and other relevant processes.

At WCHC, we embrace diversity and we dont discriminate against employees or applicants based on gender identity or expression, sexual orientation, race, religion, age, national origin, citizenship, disability, pregnancy status, or veteran status.