Medical Staff Credentialing Specialist jobs in Rapid City, SD

Rapid City Medical Center is seeking a full-time Insurance Specialist who will be responsible for all aspects of healthcare claim denials and accounts receivable. The ideal candidate will ensure all claims are submitted timely, accurately, and in accordance with payor and organization policies and procedures. As an Insurance Specialist, you will assist with payor audits, identification of claim processing trends, and be responsible to review and understand billing policies and procedures. The ability to work well independently and within a team in a collaborative environment is essential.

No nights, no weekends, no holidays!

Who We Are:

Rapid City Medical Center is a physician clinic providing excellence, choice, and patient-inspired care. We focus on building relationships with our patients, regularly connecting as partners on the journey of health. Our physicians use leading-edge technology to augment their medical skills. Ninety physicians and advanced practice providers work together with over 400 employees to make physician and test appointments efficient and effective and insurance interactions workable.

We thrive on working with smart, caring people. What we do is sometimes hard - but we do it because we serve our families, friends, and neighbors in something meaningful. Work-life balance and career satisfaction are important to us. We offer unmatched benefits, competitive wages, and the opportunity to feel great about your job.

We offer an outstanding benefits package that includes health, dental, 401k, profit sharing, life insurance, short-term disability, and long-term disability, seven paid holidays and floating birthday, paid time off (PTO) accrual, as well as flexibility in the schedule to accommodate important personal and family milestones. 

PREFERRED EXPERIENCE:  One year of experience in a billing office working with claims submissions to insurance companies.  Experience in working with insurance companies regarding insurance claims and denials.

ESSENTIAL FUNCTIONS:

• Responsible for insurance accounts receivable
• Follow up on unpaid claims utilizing the established workflows
• Responsible to ensure claims are worked in the proper manner; ensure all corrected claims and appeals are completed correctly and in a timely manner
• Assist in payor audits by collecting, reviewing, and collaborating with multiple departments to submit information and responses in a timely manner
• Responsible to review updates and policy changes communicated by payors via newsletter or other correspondence
• Communicate identified trends to varying levels of leadership
• Collaborate with multiple departments to resolve identified trends and workflow improvements
• Maintains patient confidentiality
• Performs other duties as assigned

KNOWLEDGE, SKILLS, AND ABILITIES:

• Knowledge of medical terminology, medical billing, insurance claims processing, and collection practices
• Ability to read and interpret an Explanation of Benefits
  
• Knowledge of a practice management and EMR system, eClinicalWorks preferred
• Ability to multi-task and work under pressure in a deadline driven environment with changing priorities
• Ability to communicate clearly in person, in writing, and on the phone to establish/maintain cooperative relationship with patients, families, physicians, staff and other customers
• Strong organizational and problem-solving skills
• Strong customer service skills
• Basic knowledge of Microsoft Word and Excel
• Skill in using web-based healthcare coding programs and systems
• Ability to examine insurance documents to ensure accuracy and completeness
• Ability to prepare insurance records in accordance with detailed instructions

PHYSICIAL AND ENVIRONMENTAL WORKING CONDITIONS:

• Job requires largely sedentary role requiring one’s ability to sit for extended period of time.
• Ability to occasionally lift and/or move up to 10 pounds.
• Must be able to talk, listen and speak clearly on telephone

This description is intended to provide only basic guidelines for meeting job requirements.  Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or veteran status.