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Credentialing/Insurance Specialist

Company: Boice-Willis Clinic
Location: Rocky Mount
Posted on: January 17, 2022

Job Description:

Boice-Willis Clinic in Rocky Mount, NC is seeking a Credentialing/Insurance Specialist. The specialist is a highly motivated professional with knowledge and/or experience in a multi-specialty physician office. Responsible for credentialing process for all physicians and extenders of the Clinic. Oversee on-going activities related to the development, implementation, maintenance of, and adherence to Boice-Willis Clinic's policies and procedures covering the privacy of, and access to, patient health information in compliance with federal and state laws and the Clinic's information privacy practices.
Credentialing Responsibilities:

  • Coordinate credentialing and recredentialing process for physicians and extenders with insurance companies and all practicing facilities
  • Ensure all required licensure and certifications are updated and records maintained accurately for practice locations and physicians
  • Ensure CAQH information is updated in a timely manner
  • Work with malpractice carrier to ensure coverage is updated and maintained
  • Update and distribute weekly credentialing reports
  • Manage all aspects of the payer enrollment and re-enrollment process
  • Maintain a current knowledge of all components of the process as well as information management
  • Process the workflow regarding insurance enrollment and credentialing processes for all practitioners
  • Maintain current knowledge of all verification procedures, data entry procedures and report development and production
  • Serve as resource to other staff members in reference to credentialing for all insurance enrollment and credentialing procedures
  • Participate in performance improvement activities on all aspects of the insurance enrollment and credentialing process
  • Adhere to the confidentiality policy
  • Communicate appropriately with Physician's regarding credentialing and insurance enrollment for new providers and new practices with government and commercial insurance carriers
  • Maintain a current list of providers NPI and other insurance related ID numbers
  • Contact employed/contracted physicians as necessary to maintain current and accurate information within NPPES, CAQH, and Physician credentialing files.
  • Maintain a working knowledge of applicable Federal, State, and Local laws and regulations, including the Standards of Conduct, Code of Ethics, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behaviors
  • Supports and conducts one's self in a manner consistent with customer service expectations. -Insurance Responsibilities:
    • Initiate timely collection and disposition of unpaid claims including all denials, appeals, and secondary coverage with the appropriate insurance carrier
    • Research and resolve underpayments with insurance carrier as per billing contract
    • Contact patients regarding balances, outstanding claims, and assisting with denials if necessary
    • Update patient demographics by utilizing third party payer on-line resources to verify insurance benefits, coordination of benefits, check claim status, and file corrected claims directly with payer if required
    • Process all credit balances and refund requests to insurance companies and patients
    • Perform contractual adjustments with supporting documentation with administrative approval
    • Perform other duties or special projects as assigned by manager
    • Maintain confidentiality of all patient privacy and policy information
      Education & Experience
      • High school graduate or equivalent. Associate degree in Medical Office Billing is preferred.
      • 2 years of relevant medical billing/collections experience is required.
      • Credentialing experience is preferred.
        Required Skills/Abilities
        • Knowledge of medical coding, federal and carrier procedures and regulations.
        • Strong analytical, problem solving and planning skills.
        • Ability to work effectively independently and multi-departments.
        • Requires strong data entry skills and attention to detail with proficiency in Microsoft Office Suite (Excel, Word, Access, and PowerPoint).
        • Ability to display sense of urgency while remaining organized with attention to detail.
        • Excellent customer service, oral and written communication skills, organization, and attention to detail with limited supervision necessary.
        • Medical or Multi-specialty billing experience, knowledge in payment posting, medical necessity requirements, coordination of benefits, refund processing, customer service, or claim appeals.

Keywords: Boice-Willis Clinic, Rocky Mount , Credentialing/Insurance Specialist, Other , Rocky Mount, North Carolina

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