Location
Northbrook, IL | United States
Job description
Job Summary
The Credentialing and Billing Specialist is responsible for maintaining active status for all clinicians and physicians by successfully completing the initial and subsequent credential packages as required by regulatory agencies, commercial payors, and Medicaid and Medicare. This includes ensuring that all clinical staff have the necessary qualifications for their position and that the payor enrollment process is complete for participation. The Credentialing and Billing Specialist is also responsible for executing any designated tasks of the billing department.
Essential Responsibilities and Metrics - Serve as the credentialing point of contact for all clinicians.
- Complete credentialing applications to add clinicians and providers to commercial payors, Medicare, and Medicaid within established timeframes.
- Complete re-credentialing applications for commercial payors within established timeframes.
- Maintain individual clinician files to include up-to-date information needed to complete the required governmental and commercial payor credentialing applications.
- Ensure that the credentialing tracking system is up to date for all clinicians.
- Perform verification and authorization with multiple insurance companies ensuring that the appropriate criteria were followed and documentation is complete for contracts and renewals.
- Assist with clinician onboarding and renewals to ensure that all required documents are received for credentialing.
- Work with payors to credential and re-credential clinicians and resolve any denials or authorization issues related to provider credentialing in a timely manner.
- Notify billing staff of all credentialing and payor updates.
- Maintain confidentiality of credentialing information.
- Work with the Revenue Cycle Manager, Billing staff, and Talent and Culture staff to support the credentialing and re-credentialing process of clinical staff.
- Collect all required paperwork for clinicians and activate them in Modio
- Create EMR login and permissions, maintain and update profiles
- Maintain individual clinician files in Modio to have current licenses, COI, IMCANS
- Enroll clinicians with each Payor (based on licensure) and ensure application is approved
- Submit quarterly roster for MCO - can be done monthly to add new clinicians
- Re-validate clinicians every 3 years with Payors
- Credential new facilities with the state including NPI and IMPACT applications
- Update Payors when a clinician is no longer with Josselyn
- Update Billing, Intake and Clinical Supervisors of Payor approvals
- Maintain CAQH profiles for licensed clinicians
- Maintain company directory with Payors and update as needed
- Complete annual compliance training for Payors
- Other responsibilities and special projects as assigned.
Qualifications - Bachelors degree or related field or equivalent experience
- Knowledge of provider credentialing and its direct impact on the practice's revenue cycle
- Minimum of 3 years progressive experience in credentialing, behavioral healthcare billing; both Medicaid, Medicare, and MCOs and commercial payers; behavioral health preferred
- Proficient in billing software and Office 365 Suite; CIS and or Modio experience preferred
- Sound knowledge of health insurance providers
- Detail oriented with above average organizational skills
- Strong interpersonal and organizational skills
- Excellent customer service skills; communicates clearly and effectively
- Ability to work in a fast-paced environment and plans and prioritizes to meet deadlines
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