Credentialing Accounts Receivable Specialist

Experity is the leading software and services company for on-demand healthcare in the U.S. We provide software solutions that remove complexities and simplify operations for 5700+ urgent care clinics across the country. We create, maintain, and support products to facilitate the complete on-demand healthcare experience: from patients finding clinics and making appointments, to checking in, to clinical documentation, and to the final bill paid by the patient. Our team is committed to changing healthcare for the better by innovating and revolutionizing on-demand healthcare for millions of patients across the country.
Experity offers the following:

• Benefits - Comprehensive coverage starts first day of employment and includes Medical, Dental/Orthodontia, and Vision.
• Ownership - All Team Members are eligible for synthetic ownership in Experity upon one year of employment with real financial rewards when the company is successful!
• Employee Assistance Program - This robust program includes counseling, legal resolution, financial education, pet adoption assistance, identity theft and fraud resolution, and so much more.
• Flexibility - Experity is committed to helping team members face the demands of juggling work, family and life-related issues by offering flexible work scheduling to manage your work-life balance.
• Paid Time Off (PTO) - Experity offers a generous PTO plan and increases with milestones to ensure our Team Members have time to recharge, relax, and spend time with loved ones.
• Career Development - Experity maintains a learning program foundation for the company that allows Team Members to explore their potential and achieve their career goals.
• Team Building - We bring our Team Members together when we can to strengthen the team, build relationships, and have fun! We even have a family company picnic and a holiday party.
• Total Compensation - Competitive pay, quarterly bonuses and a 401(k) retirement plan with an employer match to help you save for your future and ensure that you can retire with financial security.

Hybrid: Experity offers Team Members the opportunity to work remotely or in an office. While this position allows remote work, we require Team Members to live within a commutable distance from one of our locations to ensure you are available to come into the office as needed.
Job Type: Full time
Responsibilities:

• Effectively manage the Accounts Receivable (AR) related to provider contracting and credentialing for assigned clients, including reviewing electronic claim rejections, claim denials, and claim processing issues
• Serve as the first line of review, research, and documentation of providers being added to the system to ensure compliant billing
• Maintain system configuration and continuous review to ensure billing continues to follow compliant guidelines
• Responsible for being the liaison between Revenue Cycle Management (RCM) and the Compliance Manager regarding contracting and credentialing to ensure compliant billing is followed
• Effectively research, identify trends, determine root cause, and document findings relating to provider contracting and credentialing issues and communicate effectively with the Accounts Receivable (AR) Supervisor, Client Success Managers (CSM), and/or Client to achieve resolution
• Prioritize workflow as required to ensure Accounts Receivable (AR) issues are reviewed and acted on in a timely fashion
• Submit corrected insurance claims and/or appeals, as necessary, with appropriate documentation based on payer guidelines
• Assist internal and external parties with questions related to contracting and credentialing (AR)
• Communicate daily with internal and external customers via phone calls and written communication
• Contribute to team effort by accomplishing related results as needed
• Maintain patient confidence by following HIPPA guidelines
• Comply with applicable laws regarding medical billing standards
• Maintain work operations by following policies and procedures
• Meet productivity and accuracy standards
• Other duties as assigned

Education and Experience:

• High School diploma or equivalent
• Minimum of one year of related experience in a business, medical or technical environment
• Understanding of medical terminology and insurance laws/guidelines
• Understanding of relevant credentialing terms
• Proficient in Windows based applications and MS office

Preferred:

• Previous experience in a medical office setting and/or experience with an Electronic Medical Record
• Knowledge of payment posting, insurance company process and ability to handle inbound and outbound billing related phone calls

Every Team Member lives and breathes our Core Values:

• Team First
• Lift Others Up
• Share Openly
• Set and Crush Goals
• Delight the Client

Our urgent care solutions include:

• Electronic Medical Records (EMR): Software that healthcare providers use to input patient data, such as medical history, diagnoses, treatment plans, medications, and test results.
• Patient Engagement (PE): Software that shows patients the wait times at various clinics, allows patients to reserve a spot in line if there's a wait, and book the appointment.
• Practice Management (PM): Software that the clinic front desk staff uses to register the patient once they arrive for their appointment.
• Billing and Revenue Cycle Management (RCM): Software that manages coding, billing and payer contracts for clinics so they don't have to.
• Teleradiology: Board certified radiologist providing accurate and timely reads of results from X-rays, CT scans, MRIs, and ultrasounds, for our urgent care clients.
• Consulting: Consulting services for urgent care clinics to assist with opening, expanding and enhancing client's businesses

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)