Provider EnrollmentBilling Specialist NOT REMOTE
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Job Location:
Soldotna, AK - USA
Monthly Salary:
Not Disclosed
Posted on:
30+ days ago
Vacancies:
1 Vacancy
Job Summary
TITLE: Provider Enrollment/Billing Specialist
REPORTS TO: Chief Financial Officer
WORK WEEK: Hours not to exceed 40 per week
WAGE CLASSIFICATION: Non-exempt
OSHA RISK CLASSIFICATION: Low
SUMMARY POSITION STATEMENT
This position exists to ensure the financial well-being of the PCHS organization through timely and accurate enrollment of all providers in insurance plans and filing of insurance claims and collection of patient accounts and ensure proper posting of payments into existing PCHS systems for medical dental and/or behavioral health. This position may be responsible for any or all the essential functions listed below in the electronic health record systems. The expectation is this position will be onsite; no remote work available. Willing to train the right candidate.
ESSENTIAL FUNCTIONS/ROLES & RESPONSIBILITIES OF THE POSITION
PROVIDER ENROLLMENT:- Complete provider and group enrollment for all PCHS sites.
- Successfully implement the entire enrollment process for all providers adhering to all timelines while maintaining strict confidentiality for matters pertaining to provider credentials.
- Effectively communicate with providers to ensure timely completion of outgoing and incoming applications.
- Complete revalidation of previous enrolled providers and groups.
- Communicate with insurance payers to resolve provider enrollment issues.
- Develop a payor contact list and keep current.
- Develop and maintain a tracking list for provider enrollment.
- Help the billing department with any payment issues relating to PPOs we contract with.
- Maintain Medicaid and Medicare Org numbers: Do updates etc.
- Maintain PPO sites for accuracy changes etc. This includes Availity OneHealth Port Medicare etc.
- Provider Billing enrollment in all PPOs plus Medicare/Medicaid/CAQH.
- Terminate providers from all Payor sources when they terminate.
- Monitor aging to ensure timely follow-up of claims resolution reduction of future denials ensuring accurate payment and escalation of issues to management as identified.
- Conduct insurance re-verification as needed through various tools and initiate billings to a new payer reprocess the claim accordingly or bill the patient.
- Manage collections.
- Complete VA prior authorizations.
- Review and appeal unpaid and/or denied claims.
- Prepare verify submit and track prior authorizations including VA.
- Verify patient coverage and insurance benefits.
- Answer patient billing questions
- Process insurance and patient refunds.
- Handle self-pay collection efforts on all unpaid accounts and submit to Collections on a timely basis.
- Audit data when necessary and/or appropriate
- Post payments adjustments and denials in systems as appropriate
- Balance daily deposits to daily postings for all systems
- Keep billing spreadsheets up to date checking daily
- Check allowables to ensure correct payment and account balances.
- Post zero pay correspondence as pertaining to: deductibles copayments and denials.
- Process credit card payments and balance credit card machine transactions daily
- Perform duties as assigned by the CFO.
POSITION REQUIREMENTS
Education: High School Graduate. Certified Medical Coder (AAPC or AHIMA) preferred but not required.
License: No license required. Certificate preferred but not required.
Experience: 3-5 years of healthcare claims processing and/or billing/coding experience preferred. FQHC experience preferred but not required. Willing to train the right candidate.
Must pass a State required background check plus a pre-hire drug screen.
CONTACT INFO
- Patty Eissler Chief HR Officer emailprotected
- Website:
PCHS is an equal opportunity employer and ADA compliant agency.
Required Experience:
Manager
Key Skills
- Medical Collection
- Accounts Receivable
- Athenahealth
- ICD-10
- Medical Coding
- 10 Key Calculator
- Detailing
- ICD-9
- Medical Billing
- Microsoft Excel
- CPT Coding
- Medicare
About Company
Find the best in medical care, dental care, and behavioral and mental health care at Peninsula Community Health Services of Alaska. Call 907-262-3119.
