Medical Billing and Credentialing Specialist

JOB TITLE:

Medical Biller and Credentialing Specialist

COMPANY:

THERAPY INSIGHTS PRACTICE

POSITION TYPE:

Full-Time with benefits (can work remote)

PRACTICE WEBSITE:

https: //www.therapyinsightspractice.com

SUMMARY OF POSITION:

Therapy Insights Practice seeks a diligent Medical Billing and Credentialing Specialist dedicated to the meticulous management of our medical billing cycle. The ideal candidate will possess expert knowledge in Credentialing, DSM-5 diagnosis, ICD-10, CPT coding, and HCPCS coding, coupled with experience in using electronic health records and practice management software. Key responsibilities include overseeing the entire revenue process from claims submission to payment processing, ensuring compliance with industry standards, and actively participating in the verification and education of billing practices. The role demands proactive communication with both clients and insurance providers to address any billing inquiries or discrepancies. Applicants should be committed to ongoing professional development to stay current with industry regulations. Join our team and contribute to our mission of optimizing practice efficiency and enhancing client satisfaction through exceptional billing management.

Key Responsibilities:

Revenue Cycle Management:

Review and analyze medical records to accurately assign ICD-10-CM, CPT, and HCPCS codes for billing. Oversee the entire revenue process including claims submission, payment processing, denial management, and appeals to maximize revenue generation.

Claim Handling and Client Communication:

Utilize Availity for claim verification, upload Explanation of Benefits (EOBs) to client portals like TherapyNotes, and ensure clients are informed about their financial responsibilities.

Billing and Compliance Operations:

Manage patient information using electronic health records (EHR) and practice management software. Ensure compliance with industry standards and regulations using platforms like Alma and Headway to submit claims to major insurance providers (Aetna, Unitedhealthcare, Cigna, MagnaCare, BCBS).

Collaborative Documentation and Education:

Work with management and clinical staff to secure and verify necessary documentation for billing. Educate both clients and clinicians on proper billing codes and operational procedures, and provide support through responsive communication.

Benefits Analysis and Education:

Analyze benefit options to determine the most beneficial approach for clients, educating both clinicians and clients on the nuances of incident-to billing.

Supervision and Compliance Assurance:

Monitor and ensure that clinicians under supervision provide accurate insurance information to clients. Regularly reinforce documentation standards and address concerns with supervisory or HR personnel.

Billing Communications and Industry Compliance: Maintain active communication with insurance companies and patients to address billing queries and discrepancies. Keep abreast of changes in industry regulations and practices through ongoing education and professional development.

Direct Client Support:

Serve as the initial contact point for client billing inquiries, coordinating directly with insurance companies and partners such as Alma or Headway to enhance billing efficiency.

Financial Management and Auditing:

Prepare and distribute patient invoices, manage financial records, assist with remittance processing, and participate in audits and meetings with billing partners.

Credentialing and Internal Billing Integration:

Support clinicians through the credentialing process and ensure compliance with relevant standards. Transition billing processes to internal systems post-renegotiation of service rates to boost revenue.

Revenue Enhancement Strategies:

Identify and implement strategies to enhance billing practices and expand revenue opportunities within the practice.

Policy Development and Workflow Optimization:

Create and enforce office policies to streamline operations, enhance patient satisfaction, and ensure regulatory compliance.

Staff Development and Quality Assurance:

Conduct regular staff meetings and evaluations, offer training and coaching, and provide feedback to maintain high standards of service delivery, especially for new clinicians.

Regulatory Compliance and Certification Management: Ensure ongoing compliance with HIPAA and other regulatory standards, keeping the practice current with all necessary certifications and licenses.

Skill Requirements:

The ideal candidate for this role must possess a wide range of skills including excellent communication, effective team collaboration, and the ability to conduct onboarding trainings for new clinicians. Proficiency in medical billing and terminology is essential, with specific expertise in CPT coding, ICD-9, and ICD-10. Experience with audits, codes for psychotherapy services, and medical software such as Therapy-Notes, Availity, Office Ally, Alma, and Headway is required. Familiarity with commercial insurances like AETNA, BCBS, UHC, and CIGNA, as well as Medicare, is crucial. Candidates should also be skilled in using tools like Slack, Zoom, QuickBooks, Google Workspace (including Google Sheets and Docs), Microsoft Word, and Excel. Additional qualifications include insurance credentialing, CAQH, Google Voice, managing malpractice insurance, and handling NPI type 1 and 2, billing statements, and invoicing tasks.

Job Type: Full-time

Pay: $21.59 - $26.00 per hour

Expected hours: 25 – 40 per week

Benefits:

• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift

Work setting:

• Hybrid work
• Office
• Telehealth

Experience:

• Medical billing and Credentialing: 3 years (Preferred)

Work Location: Hybrid remote in New York, NY 10018