JOB TITLE:  Credentialing Specialist
REPORTS TO:  Credentialing Supervisor

JOB SUMMARY:
The Credentialing Specialist is responsible for credentialing and recredentialing providers contracted with STI for said services. Provides integral support to healthcare operations by enabling timely onboarding of healthcare providers. Credentialing functions include, but are not limited to, processing credentialing applications, updating and maintaining credentialing database in accordance with internal policies and procedures, CAQH maintenance, and complying with applicable state and federal requirements.

DUTIES & RESPONSIBILITIES:

• Initiate and support the practitioner application process by sending, receiving, and analyzing practitioner documents and data import to determine completeness in preparation for the payor application process.
• Efficiently perform all aspects of initial credentialing and recredentialing process to ensure current credentials and timely handoff and/or review and approval of practitioner files.
• Respond to all practitioner, client health plan and internal inquiries within 1 business day.
• Maintain electronic data files for CAQH to submit practitioner data, as required.
• Responsible for accurate data entry to ensure the integrity of credentialing information in applicable database(s).
• Collaborate with participating clients, department manager and/or external agencies to facilitate and ensure smooth hand-off from enrollment completion to billing.
• Submit tasks for invoicing.
• Use critical thinking skills to conduct follow-up with individual practitioners and internal and external entities to resolve discrepancies identified during the credentialing process.
• Actively participate in team meetings and process improvement initiatives to continuously improve work product quality and efficiency.
• Keep Manager informed of potential credentialing or enrollment issues.
• Perform duties in a timely manner as required by clients and company.
• Be an STI advocate at all times.
• Other duties, as assigned.

JOB REQUIREMENTS:

• High School diploma or GED.
• Experience should include responsibility for medical and professional credentialing processes, policies and procedures and delegated credentialing requirements.
• Must have strong organizational skills.
• Able to work well under tight deadlines and respond to rapidly changing demands and provide efficient follow up.
• Capable and comfortable dealing with sensitive and confidential information with discretion and trust.
• Strong oral and written communication skills.
• Problem solving and analytical skills.
• Computer data entry.
• Proficiency with MS Office Suite.
• Ability to follow instruction and adhere to company policies and procedures.
• Must be a team player and willing to learn and take on new responsibilities.
• Ability to represent STI in a professional manner at all times.

TO SUBMIT A RESUME, PLEASE USE THE FORM BELOW:

JOB TITLE:  Medical Billing Specialist

An established RCM company is seeking an experienced Medical Billing Specialist to provide revenue cycle management services for independent physicians and group practices. 

RESPONSIBILITIES INCLUDE:
• Maintenance of data files received from client in an organized fashion.
• Submission and verification of electronic insurance claims.
• Editing of electronic insurance claim denials for resubmission.
• Production and mailing of paper claims w/ necessary attachments.
• Processing of appeals to facilitate claim denials.
• Production and mailing of secondary claims with EOBs attached.
• Production and review of electronic patient statements.
• Coordination of patient account collection agency activity.
• Posting and balancing of payments received.
• Processing of patient and insurance refunds.
• Processing of returned patients checks.
• Working the aged accounts receivable report to follow up on past due claims.
• Production of end-of-month financial reports for managerial review.
• Production of specialty requested reports as needed.
• Assisting clients with credentialing issues and fee schedule renegotiation.
• Providing coding guidance as needed (CPCs on staff)
• Providing telephone/email support for physicians and patients as needed.

JOB REQUIREMENTS:
• Must have two years of applied experience in billing, health care field preferred.
• Knowledge of Medicare, Medicaid and Private Insurance billing regulations preferred.
• Strong computing and software skills (PC, MS Word, Excel, Outlook)
• Solid written and verbal communication skills.
• Knowledge of ChartMaker Practice Manager software a plus.

TO SUBMIT A RESUME, PLEASE USE THE FORM BELOW: