Job Abstract

Purpose:
This hybrid role is designed to assist the practice in credentialing activities, processing applications for physician privileges, and handling additional claim processing duties. Responsibilities include reviewing insurance, receiving and posting payments to patient accounts, and maintaining accurate records of collections and account statuses.

Functions and Responsibilities:

Coordinate and maintain the credentialing and re-credentialing process for all physicians and optometrists.
Conduct collection calls and/or correspondence in a fast-paced, goal-oriented collections department.
Prepare credentialing files and applications, ensuring completeness and accuracy.
Collect and process verification and accreditation information, including education, training, experience, licensure content, and DEA certification.
Monitor all physician/business licenses and malpractice insurance to ensure records are up-to-date and consistent.
Respond to inquiries from other healthcare organizations regarding credentialing and privileging issues.
Assist in the claims collections process.
Provide customer service regarding collection issues as applicable according to client contracts.
Differentiate between in-network and out-of-network insurance groups.
Resolve insurance discrepancies and short payments.
Contact and inquire with insurance companies for collections.
Identify issues and provide suggestions for resolution.
Review account information and necessary system applications to determine the next appropriate work activity, accurately and thoroughly documenting pertinent collection activities performed.
Perform appropriate billing functions, including manual re-bills and electronic submissions to payers. Edit claims to meet and satisfy billing compliance guidelines for electronic submission.
Manage and maintain desk inventory, complete reports, and resolve high-priority and aged inventory.
Document in detail problem/action/follow-up with insurance companies until the claim is paid.
Possess working knowledge of Explanation of Benefits (EOBs).
Assist in the verification of refund requests and medical records requests.
Initiate and resolve appeals for various insurance payers.
Respond timely to emails and telephone messages as appropriate. Communicate issues to management, including payer, system, or escalated account issues.
Perform miscellaneous administrative duties, such as answering phones, sorting and filing correspondence, ordering supplies, auditing files, and preparing reports.
Follow applicable policies and procedures and take precautions to establish a safe work environment.
Maintain strict patient protocols in accordance with practice policies and HIPAA requirements.
Maintain a high level of professionalism with patients and work to establish a positive rapport.
Perform additional duties as assigned.

Problem-Solving Skills: Candidate must possess abilities to problem solve, prioritize, and follow-through completely with assigned tasks. Candidate must possess analytical skills to examine billing information for accuracy and completeness. Candidate must have the ability to work in a fast-paced environment.
Software Experience: Competency in Practice Management systems, Clearinghouse systems, and demonstrated accuracy in claim processing. Candidate must also be competent in Medicare and online credentialling portals.

Qualifications:
* High attention to detail a must
* Medical Experience a must
* Computer proficiency (Intermediate Microsoft Suite, Word and Excel)
* Understanding of Accounts Receivable/Payable functions
* Strong Interpersonal skills
* Knowledge of medical codes a plus
* Knowledge of medical terminology and basic math essential
* Knowledge of Compulink Healthcare Solutions Software a plus



To apply please email your resume to rranderson@ultimatestaffing.com