Credentialing/Accounts Receivable Specialist

Job Description:

The Credentialing & A/R Specialist will play a critical role in managing and collecting outstanding patient balances, ensuring the accuracy of financial records, handling claims processing, and providing exceptional service to patients with billing inquiries. This position requires strong communication skills, experience in collections and billing, and proficiency in basic math.

Along with this, the role of Credentialing Specialist will be responsible for verifying credentials, maintaining accurate records, and handling the entire credentialing process from start to finish as well as be responsible for ensuring that all necessary licenses, certifications, and documentation are accurate and up-to-date. This role is crucial in maintaining compliance with state and federal regulations, as well as ensuring that our providers can deliver care without administrative disruptions.

Key Responsibilities:

• Collect Outstanding Balances: Actively manage and collect outstanding patient balances through phone calls, emails, and written correspondence.
• Balance Verification: Ensure the accuracy of patient account balances, making necessary adjustments and corrections.
• Claims Processing: Handle claims work, including submission, follow-up, and resolution of insurance claims when necessary to resolve patient balances.
• Patient Communication: Communicate with patients to address billing concerns, provide explanations, and resolve disputes.
• Insurance Eligibility: review, verify, and correct any insurance eligibility issues prior to each visit.
• Email Management: Monitor and respond to billing-related emails promptly and professionally.
• Reporting: Generate and run regular financial and billing reports to track account statuses and collections performance.
• Credentialing Process Management: Oversee the initial credentialing and re-validation process for all healthcare providers.
• Documentation Verification: Verify the accuracy and completeness of all required documentation, including licenses, certifications, education, and work history.
• Application Processing: Manage the initial and re-credentialing process, ensuring timely and accurate submission of applications to relevant agencies.
• Compliance Maintenance: Ensure compliance with all relevant regulations, standards, and guidelines, maintaining up-to-date knowledge of state and federal requirements.
• Communication: Act as a liaison between healthcare providers, insurance companies, and regulatory bodies to resolve any credentialing issues or inquiries.
• Database Management: Maintain accurate and comprehensive records in the credentialing database, updating information as necessary.
• Communication: Serve as the primary contact for providers regarding credentialing status, requirements, and documentation needs as well as communication regarding maintaining updated licenses to continue legally practicing in the state.
• Collaboration: Work closely with internal departments, insurance companies, and regulatory bodies to facilitate the credentialing process.
• Reporting: Generate and present regular reports on credentialing status and compliance metrics.

Required Qualifications:

• Collections Experience: Proven experience in collections, with a focus on medical billing and claims processing.
• Communication Skills: Excellent written and verbal communication skills to effectively interact with patients and insurance companies.
• Basic Math Skills: Ability to perform basic arithmetic operations accurately.
• Experience: Previous experience in credentialing, medical staff services, or a related field.
• Attention to Detail: Strong attention to detail and organizational skills to manage multiple provider files and ensure accuracy.
• Knowledge: Understanding of credentialing and re-validation processes, as well as relevant state and federal regulations.

Preferred Qualifications:

• Education: Bachelor’s Degree in related field
• Industry Knowledge: Knowledge or experience in the mental health field is a plus.
• Technical Skills: Proficiency in MS Office applications (Excel, Word, Outlook), G-Suite, EHR and ability to work in multiple databases, proficiency with credentialing software and insurance portals
• Certification: Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) certification is a plus.

Job Type: Full-time

Pay: $20.00 - $25.00 per hour

Work Location: In person