Job Information
The Phoenix Center Credentialing Billing Specialist in Ironton, Ohio
Overview: We are seeking a detail-oriented and experienced Credentialing/Billing Specialist to join our team. The ideal candidate will have strong organizational skills, attention to detail, and a thorough understanding of medical billing procedures and insurance credentialing processes. This position plays a crucial role in ensuring the timely and accurate processing of insurance claims and maintaining compliance with credentialing requirements. Responsibilities: Credentialing
- Manage the credentialing process for healthcare providers including physicians, therapists, and other allied health professionals
- Complete and submit credentialing applications to insurance companies and other relevant organizations
- Maintain up-to-date provider information in credentialing databases and tracking systems.
- Follow up on credentialing applications, track progress, and address any issues or deficiencies
- Ensure compliance with credentialing standards and requirements set forth by regulatory bodies and insurance plans
- Communicate with providers and insurance representatives to resolve credentialing-related inquiries or issues promptly
Responsibilities: Billing
- Prepare and submit electronic and paper claims to insurance companies for services rendered by healthcare providers
- Verify insurance eligibility and benefits for patients prior to appointments
- Review and analyze medical records to accurately code diagnoses and procedures according to billing guidelines (ICD-10, CPT, HCPCS)
- Enter and maintain accurate billing and payment information in practice management software systems
- Follow up on unpaid claims, denials, and underpayments identifying and resolving billing discrepancies
- Process appeals and resubmit claims as necessary to maximize reimbursement
- Generate and analyze billing reports to monitor revenue cycle performance and identify trends or areas of improvement
- Stay informed about changes in billing regulations, coding guidelines, and insurance policies affecting reimbursement
Qualifications: Bachelor's Degree in healthcare administration, business administration or related field preferred Minimum of 2-3 years of experience in medical billing and credentialing in a healthcare setting Knowledge of insurance credentialing processes, including CAQH,NPI, and provider enrollment applications Proficiency in medical billing software and practice management systems (e.g. EPIC, Cerner, Meditech) Familiarity with medical coding principles and code sets