Billing/Credentialing Technician

Job Description

Job Description

DESCRIPTION

This position is responsible for all aspects of the credentialing, re-credentialing and privileging processes for all providers who provide patient care at Guidance Center of Lea County, Inc. Responsible for ensuring providers are credentialed, appointed, and privileged with health plans, MCOs and patient care facilities. Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications. This position will work closely with management and GCLC employees to ensure timely and accurate submission of insurance claims as well as to facilitate effective follow-up and receipting of insurance claims.

JOB DUTIES

• Responsible for ensuring providers are credentialed, appointed, and privileged with health plans, MCOs and patient care facilities; monitors applications and follows-up as needed.
• Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.
• Maintains copies of current state licenses, certificates, malpractice coverage and any other required credentialing documents for all providers.
• Sets up and maintains provider information in online credentialing databases and system.
• Tracks license, certification, MCO and professional liability expirations for all providers to ensure timely renewals.
• Ensures practice addresses are current with health plans, agencies, and other entities.
• Maintains knowledge of current health plan and agency requirements for credentialing providers.
• Audits health plan directories for current and accurate provider information.
• Process and submit claims to multiple payors.
• Ensure all claims are submitted daily with a goal of zero errors.
• Timely follow up on insurance claim status.
• Respond to inquiries by insurance companies.
• Read and interpret EOB (Explanation of Benefits).
• Manage denied claims inventory.
• Function as back-up for other billing needs and other duties, as necessary.
• Maintains confidentiality of provider information.
• Provides credentialing and privileging verifications.
• Performs other duties as assigned.

QUALIFICATIONS AND EXPERIENCE

REQUIRED

• High School diploma or high school equivalent
• Proficient use of Microsoft Office applications (Word and Excel) and internet resources.
• Ability to organize and prioritize work while managing multiple priorities.
• Excellent verbal and written communication skills including letters, memos, and emails.
• Ability to research and analyze data.
• Excellent attention to detail and ability to multitask.
• Ability to work independently with minimal supervision.
• Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.

PREFERRED

• Prior medical claim billing experience
• Knowledge of medical terminology
• Knowledge and understanding of the credentialing process.
• Experience in CPT and ICD-10 coding.
• Experience in filing claim appeals with insurance companies to ensure maximum reimbursement.
• Bilingual (English/Spanish) preferred, but not required.

PHYSICAL REQUIREMENTS

• Prolonged periods of sitting at a desk and working on a computer.
• Must be able to lift up to 15 pounds at times.

CONDITIONS OF WORK:

Hiring and promotion will be accomplished in compliance with Guidance Center's Personnel Policies and Procedures. This position is non-exempt under the Fair Labor Standards Act. Requires a minimum 40 hours per week. Hours and/or days may vary according to need. Overtime (time and 1/2) will be paid for hours worked in excess of 40 hours per week. Travel is required of employees for delivery of services, training, or conferences. Personal transportation is mandatory.

Guidance Center of Lea County, Inc. is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran, or disability status.