Clinical Billing and Credentialing Specialist

Overview

The Clinical Billing Specialist is a Medicaid/MCO billing professional who supports the financial health and mission of the agency. A member of the Revenue Cycle team, they ensure medical and behavioral providers are credentialed with insurance payers in a timely and accurate fashion. This position also performs billing functions to achieve prompt and Billing and appropriate reimbursement while meeting compliance standards.

Key Role Responsibilities

• Perform a variety of billing functions, including charge and payment posting, processing of electronic EDI claims and electronic Explanation of Benefits (EOBs), tracking and follow-up on outstanding or denied claims, and receivable management tracking and reporting
• Review and audit critical Billing and clinical information in multiple specialties. Ensuring that diagnoses codes (ICD-9-CM coding and ICD-10-CM) support the services provided, E&M code levels support the complexity of the visit, and appropriately coded CPT procedures are properly documented in the EHR for each visit.
• Identify inaccurate coding and prepares reports of findings for staff education and training on coding practices and compliance
• Maintain up to date individual provider files for required governmental and commercial payer credentialing applications
• Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid, and re-credentialing as needed
• Create, update, and maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases
• Maintain internal provider grid to ensure all information is accurate and logins are available
• Work closely with the Revenue Cycle Manager and billing staff to identify and resolve any denials or authorization issues related to provider credentialing
• Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases

Key Agency Responsibilities

In addition to role responsibilities, every staff member has the following responsibilities as a part of their employment:

• Models and reinforces the core values of dignity, authenticity, hope, justice, passion and balance
• Actively participates in performance improvement and advocacy activities that support the mission
• Protects clients’ personal health information by maintaining compliance with HIPAA and other relevant health care-related IT security regulations
• Performs other duties on an as-needed basis

Knowledge, Experience, and Skills

Formal Education and Training

• Bachelor’s degree or equivalent experience
• Certified Professional Coder (CPC) certification preferred

Experience

• Minimum of two (2) years billing experience in a health care setting
• Experience in and knowledge of Medicare/Medicaid payer guidelines
• Familiarity with insurance verifications and prior authorizations is required
• Experience working with an EMR preferred; experience with athenaOne highly preferred
• Experience working in a federally qualified health clinic (FQHC) preferred
• Experience in a community or public health setting working with an underserved population preferred

Skills

• Excellent interpersonal and customer service skills to interact and maintain relationships with a wide range of personalities
• Strong organizational skills necessary with strong accountability and drive
• Demonstrated proficiency with databases and spreadsheets
• Strong communication skills, both written and verbal
• Able to cope with interruptions, be flexible, and be a team player

Health Care for the Homeless is an equal-opportunity employer and is committed to racial equity and inclusion. We make a particular effort to recruit and promote Black, Indigenous and People of Color (BIPOC) for open positions. BIPOC, LGBTQIA+ individuals, people with disabilities, and people with other marginalized identities are encouraged to apply.