[ref. a09099201] Credentialing and Medical Billing Specialist - Work from Home (XEN)

Position Summary:

The ideal candidate has multiple years of experience in either credentialing, medical billing, or both. Credentialing experience in multiple states or medical billing experience across multiple EMR systems is a plus. This role is perfect for someone who thrives in a dynamic environment, can easily jump into diverse client projects, and is eager to expand their skill set.

Job Details:

• Credentialing and Medical Billing Specialist
• Permanent work from home
• Following US Holidays
• Monday to Friday | EST

Responsibilities:

• Complete and submit credentialing applications with supporting documentation to commercial payers.
• Monitor application progress/status and follow up with payers until the credentialing process is complete and the provider is in network. Update logs as necessary.
• Communicate with and notify staff of any missing or expired documentation.
• Update and re-attest (as necessary) provider credentials through CAQH, Availity, UnitedHealthcare, and other portals.

• Monitor the status of medical claims to ensure prompt and accurate payment.
• Research and resolve claim rejections and denials, implementing measures to prevent future occurrences.
• Document all account activities accurately and in a timely manner.
• Post adjustments and manage collections from various types of payers.
• Understand and apply Medicare, Medicaid, and commercial insurance eligibility requirements and payment methodologies.
• Correctly record contractual adjustments based on payer contracts and government regulations.
• Exhibit proficiency with billing systems and leverage all functionality to ensure the most efficient processing of claims.
• Call payers to get updates on claims and discuss the resolution of rejected claims.
• Answer patient questions about claims (where applicable.)
• Maintain up-to-date knowledge of changes in billing and coding guidelines, payer contracts, and government regulations.
• Collaborate with team members and providers, fostering a positive and productive work environment

Qualifications:

• Minimum 5 years of hands-on experience in medical billing, with exposure to various EMR/EHR systems (e.g., Athena, Apero, etc.) OR Minimum 3 years of credentialing experience for US providers.
• Proven ability to work independently across different client environments and adapt quickly to new systems and workflows
• Strong understanding of medical billing procedures, insurance eligibility, payer requirements (Medicare, Medicaid, commercial), and denial resolution.
• Exceptional attention to detail and accuracy, especially for documentation and data entry.
• Strong organizational and project management skills; able to manage multiple credentialing and billing projects simultaneously.
• Effective written and verbal communication skills, including professional interaction with payers, providers, and patients.
• Willingness to learn and perform credentialing responsibilities in addition to medical billing duties.