Credentialing & Billing Specialist

Credentialing & Billing is an integral part of our finance department. The right candidate will have demonstrated successes as a Biller/Coder, and credentialing in a health care setting. We prefer experience working extensively with Medicaid and other payers. This candidate will need to have demonstrated a strong record of detailed-oriented, confidential, and independent work.

Do you desire an active work life that's well supported, balanced, and family-oriented? If you are detail-oriented and customer-service minded then you'll enjoy Riggs HR Department. Riggs always strives for our "Joy in Work" efforts.

At Riggs Community Health Center, you will work directly with the HR Director, Managers, Director team, and Executives to accomplish tasks ranging from HR reception to assisting with broader organizational projects. This position reports to the CFO. We need a person that will thrive in a tech-savvy, multi-tasking, office administrative role. Join Riggs finance team and reap the rewards of a fulfilling career while continuing to help our community.

Essential Duties:

• Assists CFO with managed care contracting issues and projects.
• Compiles data necessary to credential and privilege providers.
• Credentials all Riggs CHC providers with contracted payers, re-validating facility and providers, as needed
• Completes applications and requests for additional information, and works with the provider and Human Resources to gather necessary documentation.
• Completes applications, handles requests for additional information, and follows up with various organizations on status of provider’s credentialing.
• Monitors the adjustment summary report on a weekly basis to ensure that all transactions are correct and any discrepancies are corrected properly to patient accounts, by outside billing company, prior to month end.
• Reconciling specific GL accounts that relate to patient refunds, DWR adjustments, credit card payments. Assists with reconciling patient payments posted balance to actual cash received at month end.
• Maintains and updates CAQH for both Riggs CHC and individual providers.
• Work with outside billing company on billing or EHR system issues.
• Manages the Flat File Interface to convert data from the EHR to the General Ledger accounts.
• Filing the daily automatic files.
• Month end creation of all daily detail and posting flat files.
• Review of daily detail files to posting files, as well as reconciling to EHR reports, researching errors and discrepancies prior to posting, correcting and working with other departments to resolve ongoing issues.
• Requires the research of all negative balances that transfer over and correcting the posting file.
• Importing daily data of Flat File posting entries into Great Plains, and posting the journal entries.
• Back up for accounts payable and payroll processing.
• Drafts training material for PSRs, and assists in on-going training or other issues that arise, as needed.
• Monitors Medicaid panel, noting panel sizes and other requirements for UDS reporting.