Billing/Payer Enrollment Specialist (62781)

Our Mission, Vision, & Model of Care

At Union Community Care, our purpose is at the forefront of all that we do: we stand for whole health to help you live your fullest life.

We envision vibrant and healthy communities supported by inclusive healthcare that embraces each member's unique culture, needs, and values, and emboldens them to make healthful choices that fuel their well-being and the well-being of others.

We believe in whole health. This means we address and heal disease but equally important, we work at the causes of the causes, the social ills that must be addressed to achieve true equity.

We listen, learn, and embrace the complex lives and unique strengths of our patients, and we work hard to break down all barriers to care. This means we look through a grassroots lens. We connect with our communities because we are our communities. Each of us is a neighbor, a friend, a family member, and together, we are a trusted community health center.

Job Duties:

• Completing all initial payer enrollment applications for commercial and government payers and completing timely follow up.
• Completing and maintaining all CAQH profiles for all providers
• Ensuring that re-credentialing and revalidations are completed timely to prevent any lapse in enrollment
• Maintenance of credentialing and billing information in the Credentialing enrollment system
• Communicating with payers, providers, and other entities to quickly and accurately obtain or provide information beneficial to the credentialing or enrollment needs of the organization
• Maintaining knowledge of current health plan and agency requirements for credentialing
• Ensuring practice addresses are current with government and commercial health plans, agencies and other entities
• Maintaining confidentiality of provider information
• Terminating enrollment with government and commercial payers upon resignation or termination of providers
• Updating and maintaining National Provider Identification files for locations
• Using the electronic billing system, along with any of the organization's proprietary spreadsheets or software, purchased or leased, as the primary source of immediate notification and maintenance of enrollment related data
• Responding to the enrollment services dashboard tasks and overall maintenance and content
• Communicating with Athena Health Enrollment Services as needed both verbally or through tasks and cases
• Monitoring worklists to identify increases in accounts receivable or claims denials related to enrollment and credentialing issues, and working toward resolution
• Collaborate with Billing Specialist on any issues related to payer enrollment.
• Processes and posts insurance payments along with patient payments in an accurate and timely manner in accordance with Union Community Care's policies, procedures and performance goals.
• Coordinates with PAS to ensure accurate patient information for billing purposes
• Performs a variety of general clerical duties, including telephone reception, mail distribution, and other routine functions.
• Works Claim Holds and Denials by investigating (calling), correcting and resubmitting claims to third party payers
• Answers questions from team members, patients and insurance companies
• Maintains patient demographic information, including insurance eligibility and benefit verification
• Participates in educational activities and attends staff meetings
• Maintains strict confidentiality and adheres to all HIPAA guidelines and regulations
• Performs other work-related duties as assigned

SPECIFIC JOB DUTIES- Billing Team Lead

• Performs all duties of Billing/Payer Enrollment Specialist
• Works with Billing Specialists to research appropriate billing & coding procedures
• Works with Director of Billing to maximize revenue potential based on our unique services and providers
• Works with Director of Billing to maximize department efficiency
• Assists with reconciliation errors
• Works with Accounting to identify any discrepancies in cash
• Keeps ongoing knowledge of current CPT/CDT guidelines and educates Billing Specialists
• Responsible for Training of Billing Staff
• Assists with Training of PAS

Certification in Medical Billing or Coding preferred

Qualifications, Skills and Knowledge Required:

• 3 years minimum experience in a payer enrollment related field
• Knowledge and thorough understanding of managed care operations including enrollment, credentialing, contracting and claims
• Knowledge of payer processes, local, state, and federal requirements
• Excellent written and oral communication skills
• Strong organizational, problem solving and decision-making skills
• Ability to prioritize and manage multiple projects and issues effectively and simultaneously
• Self-motivated and self-starter who can work well under minimal supervision
• Strong attention to detail, research and follow up skills
• Knowledge of medical terminology and current CPT OR CDT coding practices preferred
• Working knowledge of Microsoft Office, EMR software's and other online programs; along with general business equipment
• Basic mathematic skills
• Spanish proficiency preferred
• Ability to work well with others

ESSENTIAL FUNCTIONS

To fulfill the requirements of this position, all duties are considered essential functions of the job.

ORGANIZATIONAL INVOLVEMENT

This position is required to participate in mandatory all staff meetings, team meetings and trainings.