• 5
  • Apr
  • 0

Credentialing and Billing

Job Description

Responsible for the collection and review of credentialing documents to ensure the accuracy of all enrollment applications and re-credentialing documents submitted to payers. Support the Manager and Director in the efforts to confirm the credentials and primary data source verifications of physicians and mid-level providers joining UrgentWay. This includes direct communication with providers, payers, clinic personnel, Operation Directors and Managers and Executive Directors as needed, report generation, data entry, primary data source verification, attestation, preparation of enrollment documents to be forwarded to the provider and other duties as assigned. Function requires the highest level of accuracy and confidentiality. Performs all duties as assigned.

Qualification

  • Several recent years of Professional Medical Billing experience
  • Strong Medical Billing Background
  • Ability to communicate clearly and effectively
  • Proficient in Microsoft Excel
  • Exposure to Account Receivable processes
  • Impeccable professional reputation with high degree of energy, integrity, and positive spirit

Duties and responsibilities

A candidate’s Duties and responsibilities will include:

  • Follow up on all claims from billing through final resolution
  • Work on aged receivables
  • Review and prepare claims for manual and/or electronic billing submission
  • Correct and identify billing errors and resubmit claims to insurance carriers
  • Follow up on payment errors, low reimbursement, denials, etc
  • Review Insurance EOB’s and initiate appeals as necessary
  • Check each insurance payment for accuracy and compliance with contract discount
  • Call insurance companies regarding any discrepancy in payments if necessary
  • Identify and bill secondary or tertiary insurances
  • Maintain strict confidentiality; adhering to all HIPAA guidelines/regulations

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