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Billing and Credentialing Specialist

Catholic Charities - Diocese of Des Moines Des Moines, IA
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Catholic Charities has an immediate need for a highly motivated individual to join our team!  As the Billing and Credentialing Specialist, you will be responsible for the oversight of the billing system for our   Program, including data entry of client demographics, claims entry and transmission, Explanation of Benefits/Electronic Remittance posting, accounts receivable tracking, client statements, research and follow up with insurance carriers on denied or rejected claims.  This position performs all aspects of individual provider and facility enrollment, credentialing, and re-credentialing activities, counseling support, and maintains up to date, complete and accurate files of all required facility and individual provider enrollment/credentialing/licensing related information in support of the mission, vision and strategic initiatives of Catholic Charities and its stakeholders.        

 

ESSENTIAL DUTIES and RESPONSIBILITIES

  • Obtains pre-authorizations for covered facilities, initiates client billing, CPT coding, and submits insurance claims to clearinghouse or individual insurance companies.

  • Processes new claims, corrected claims, and appeals. Responds to denials, questions and resolves issues in a timely manner to ensure client and office practice satisfaction.

  • Works on claims and claim denials to ensure maximum reimbursement for services provided.

  • Prepares and transmits claims using software, including electronic and paper claim processing.

  • Post charges and submits claims to payers within standard billing cycle timeframe.

  • Follows established billing policies, procedures and regulations in compliance with HIPAA and Medicare, Medicaid and insurance payers. 

  • Verifies insurance payments and client accounts for accuracy and compliance with contract discount. Contact insurance companies regarding any discrepancy in payments

  • Generates regular revenue and billing chart audits for quality control, accuracy, and completeness.

  • Identify applicable billing for secondary or tertiary insurances.

  • Works closely with vendors to update billing software, rate changes and applicable spreadsheets.

  • Sets up patient payment plans.

  • Ensures all eligible therapists are credentialed with insurance panels

  • Ensures all therapists are registered, certified, and re-attests quarterly with the Council on Affordable Quality Healthcare (CAQH) and other insurance/credentialing clearinghouses

  • Responsible for all Electronic Data source Interchange (EDI) enrollments with insurance carriers.

  • Maintains professional records on therapist licensure, credentialing and specialized certification

  • Retrieves documents and back up information as requested.

  • Files all documents as directed on a weekly/monthly basis or as required.

  • Attends agency meetings and staff development programs as required.

  • Other duties as assigned.

 

KNOWLEDGE, SKILLS, AND ABILITIES

  • Knowledge of commercial credentialing policies and applicable government regulations and standards, and the ability to actively apply that knowledge in the performance of all job duties

  • Familiarity of private and commercial insurance carriers including Medicare and Medicaid

  • Ability to identify, investigate, and resolve unpaid claims, which includes researching individual payer policies and submitting claims appeals

  • Excellent organizational skills

  • Excellent verbal and written communication skills

  • Skilled in using computers; skilled in typing/keyboarding with typing speed of 40 wpm or greater preferred

  • Knowledge of general and credentialing-related computer programs

  • Ability to practice confidentiality and follow HIPAA regulations with client information;

  • Familiarity of Electronic Health Records systems

  • Ability to recognize a problem and effectively problem-solve, accessing guidance from other resources when necessary

  • Ability to manage time efficiently, prioritize, multi-task, and adapt to change

  • Ability to maintain high level of accuracy in all documentation and in the performance of all job duties

  • Ability to perform the essential job duties within the scope of education and training

  • Ability to work independently while promoting and maintaining a productive team working environment

 

CERTIFICATES, LICENSES, REGISTRATIONS

Medical billing or credentialing certification preferred

Instant Answers
providedProvided by company
Full-time Employee
Date Posted February 3, 2023
Date Closes March 5, 2023
Located In Des Moines, IA
Job Type Full-time Employee
SOC Category 43-1011.00 First-Line Supervisors / Managers of Office and Administrative Support Workers
Zipcode 50309

This job offers the following benefits

  • 403(b) Retirement Savings Plan
  • Flexible Spending Accounts
  • Dental
  • Life Insurance
  • Medical
  • Paid Holidays
  • Paid Vacations
  • Travel Stipends

This job requires the following skills

  • Bank Lending
  • Manufacturing - Customer Service
  • Manufacturing - Management
  • Public Administration - Volunteer Administration
  • Electronics and Appliance Management / Supervision
  • Retail Customer Service
  • Product Management
  • Mobile Electronics Repair
  • Transportation - Technology Specialist
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