Medical Staff Credentialing Specialist, Sr. jobs in Anderson, SC

About us

Patriot Hospice is proud to be an Equal Opportunity Employer. We believe in people, and we are committed to working with people of all backgrounds and connecting them with clients and companies who share our goals of diversity and inclusiveness. All qualified applicants will receive consideration for employment without regard to race, religion, ancestry, color, national origin, age, gender identity or expression, genetic information, marital status, medical condition, disability, protected veteran status, sex (including pregnancy), sexual orientation, or any other characteristic protected by applicable federal, state, or local laws.

We are looking for a Medical Billing and Credentialing Specialist for a small practice in Easley, SC. The individual in this role will need to have a strong knowledge of medical benefits and their plans, excellent attention to detail, and critical thinking skills. This position is full-time and in-office.

ESSENTIAL FUNCTIONS:

Billing:

• Reviews, researches and resolves insurance claims, unprocessed third-party claims, denials, underpayments and overpayments.
• Verifies accuracy of billing data and corrects errors; resubmits clean claims to payers electronically or via paper claim.
• Works, monitors, and manages his/her respective workbaskets including, but not limited to, denials, 60 day, 90 day, 120 day aging on assigned insurance carrier(s) to get claims paid in a timely manner.
• Works incoming mail and EOBs (Explanation of Benefits) from the insurance carriers and processes claims related correspondence to resolve issues.
• Works EDI transactions, ERA files and rejection reports.
• Contacts payers via phone to help expedite the resolution of claims and payments.
• Accesses web-based applications and internet for claim status and eligibility of services.
• Identifies and resolves patient billing complaints and inquiries. Assists the overflow customer service line when volume of incoming calls warrants assistance.
• Complies with Patient Accounting quality and productivity standards.
• Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
• Other duties and responsibilities as assigned by supervisor.

CREDENTIALING:

• Collects and processes required documents for credentialing.
• Complies and maintains current and accurate data for clinicians, including current state licenses, DEA certificates, malpractice coverage, and any other required credentialing documents.
• Tracks medical licensure and DEA certification for all clinicians for CAQH Maintenance.
• PECOS Reassignment of Providers.
• Medicare, Medicaid, other insurance credentialing for 7-10 providers.

MINIMUM QUALIFICATIONS:

• High School Diploma or equivalent required
• Three (3) years medical billing experience
• Strong knowledge of Medicare claims processing regulations and other payer specific guidelines
• Strong written and verbal communication skills
• Ability to establish and maintain cooperative working relationships and the ability to work in teams.
• Proficiency in Microsoft Office programs such as Word, Excel, Teams, and Outlook.