Duties/Responsibilities:
Claims Processing
- Submit insurance claims accurately and timely via SimplePractice.
- Verify client insurance benefits and coverage details 7 days out from scheduled appointment.
- Verify OHP eligibility and understand authorization requirements for mental health services.
- Follow up on claim denials and resubmit corrected claims.
- Review and post payments from EOBs (Explanation of Benefits).
- Communicate with clients regarding billing questions and payment arrangements.
- Process Oregon Health Plan (OHP) claims with knowledge of CCO requirements.
- Understand Oregon Medicaid billing codes and documentation requirements.
- Maintain accurate records for OHP reporting and audit compliance.
- Other duties as assigned.
Credentialing
- Manage end-to-end credentialing and re-credentialing for all providers within the practice
- Submit and track enrollment applications with Oregon Health Plan (OHP) and applicable CCOs to ensure providers can bill services
- Maintain accurate provider records including licenses, certifications, NPI, CAQH profiles, and malpractice insurance
- Partner with the Director of Compliance to ensure compliance with Oregon Health Authority (OHA) and payer-specific requirements for behavioral health services
- Coordinate primary source verification of licenses and credentials with Oregon licensing boards
- Track credentialing status and follow up with payers to prevent delays in provider onboarding or reimbursement
- Manage re-credentialing timelines and proactively track expirations to avoid lapses in coverage
- Partner with billing to confirm provider enrollment prior to claim submission and resolve credentialing-related denials
- Act as the main point of contact for providers regarding credentialing status, requirements, and updates
- Maintain organized digital files for all credentialing documentation and audit readiness
- Identify and implement simple process improvements to streamline onboarding and reduce time
Administrative Support
- Data entry into ROADS portal.
- Assist with client scheduling and appointment coordination as needed.
- Maintain organized filing systems for billing records and documentation.
- Support clinicians and other personnel with the Simple Practice EHR as needed.
- Provide general administrative support to clinical and administrative staff as directed.
- Set clear goals and develop realistic timelines to achieve them.
- Maintain a manual with step-by-step instructions for billing processes.
- Create reports for finance as-needed.
- Approach work collaboratively and with a genuine investment in team growth.
- Other duties as assigned.
Qualifications and Skills
- Alignment with our company’s culture, mission, and values.
- 2+ years of experience with Oregon Medicaid/OHP billing and claims processing.
- 2+ years of experience with Behavioral Health credentialing.
- Experience with medical billing software, preferably SimplePractice.
- High school diploma or equivalent; additional training in medical billing or healthcare administration preferred.
- Strong attention to detail and excellent organizational skills.
- Professional demeanor with ability to handle confidential information.
- Ability to work independently and manage multiple priorities in a fast-paced environment.
- Strong communication skills and collaborative approach to supporting team goals.
- Reliable attendance and commitment to maintaining accurate billing records.
Equal Opportunity Employment
Sprout Therapy PDX is an equal opportunity employer. We are committed to providing equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, gender identity, genetic information, or any other characteristic protected by applicable law. Sprout Therapy PDX complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has employees. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.
Sprout Therapy PDX is committed to providing accommodations to individuals with disabilities. If you require accommodations, please contact Leadership to discuss your needs.
Please note that this job description is not intended to be a contract, implied or otherwise, and may be revised or updated at any time at the discretion of Sprout Therapy PDX. Employment with Sprout Therapy PDX is at-will, meaning that both the employee and Sprout Therapy PDX have the right to terminate the employment relationship at any time, with or without cause or notice.