Revenue Cycle Coordinator - CPC

Revenue Cycle Coordinator

To transform lives by providing exceptional, accessible, and compassionate healthcare experiences for all.

Care Alliance will be the health center of choice, delivering compassionate, high-quality, and innovative healthcare that empowers individuals and strengthens communities. We are committed to advocacy, access, and excellence, ensuring every patient receives the care they deserve with dignity, respect, and unwavering support.

The Revenue Cycle Coordinator at Care Alliance Health Center will manage all billing and credentialing activities to ensure timely and accurate claims processing and provider enrollment with insurance payers. This role is essential in maintaining the organization's financial health by ensuring compliance with billing regulations and payer requirements while optimizing revenue cycle efficiency. This role reports directly to the Revenue Cycle Manager.

Competencies & Responsibilities:

• Review and reconcile claims for errors or inconsistencies, ensuring compliance with payor guidelines and regulations.
• Accurately process and submit claims to insurance companies, Medicaid, Medicare, and other payers.
• Follow up on denied or unpaid claims, identifying and resolving issues to maximize reimbursement.
• Assist in preparing and submitting appeals for denied claims in a timely manner.
• Monitor accounts receivable and generate reports for management to track billing performance.
• Coordinate initial and re-credentialing processes for providers, ensuring compliance with payer requirements.
• Prepare and submit provider applications and maintain accurate documentation for insurance panel enrollment.
• Track credentialing statuses, renewal dates, and expiration deadlines to ensure continuity of participation in payer networks.
• Communicate with insurance carriers to resolve credentialing and enrollment issues promptly.
• Stay current on billing and credentialing regulations, payer policies, and coding updates to ensure adherence to industry standards.
• Maintain thorough and accurate records of all billing and credentialing activities, including contracts, applications, and communications.
• Assist in audits and quality assurance checks to ensure compliance with internal and external standards.
• Serve as a liaison between providers, insurance payers, and internal departments to facilitate efficient billing and credentialing processes.
• Educate providers and staff on billing and credentialing requirements as needed.
• Provide excellent customer service to patients and providers by addressing billing inquiries and resolving issues promptly.
• Bill for transportation charges, prepare daily deposits to be uploaded

Qualifications:

• High School Diploma or equivalent required; associate's degree in business administration, Healthcare Management, or related field preferred.
• Minimum of 2 years of experience in medical billing and credentialing, preferably in a community health center or healthcare setting.
• Proficiency in medical billing software, electronic health records (EHR), and Microsoft Office Suite.
• Strong understanding of medical coding (CPT, ICD-10) and payer requirements.
• Excellent organizational skills with the ability to manage multiple tasks and meet deadlines.
• Certification in Professional Coding (e.g., CPC) required.