Job Description

Function:

The Billing & Credentialing Specialist will work as part of the billing team to maximize the efficiency and accuracy of Ramey-Estep/Re-group (RE) billing activities. This will be achieved by reviewing prebilling reports to maximize payments, improving current processes, and reviewing post-billing reports to track denial trends to minimize denied and outstanding claims. This position will also assist in the management of the enrollment and credentialing process for healthcare providers.

Organizational duties & responsibilities:

1. The primary responsibility of all staff is to ensure the safety and well-being of all Ramey-Estep/Re-group (RE) clients.
2. Supports the mission, vision, and values of RE.  Facilitates and adheres to the agency’s code of ethics, policies, and procedures.
3. Supports all functions that attain and maintain accreditation and compliance with regulatory agencies.
4. Supports and facilitates positive interaction with clients and staff by exhibiting both in-office and in-public when carrying out job duties:  individual maturity, respect for others, a team-centered approach, maintenance of confidential information, and awareness and sensitivity to cultural and other differences in clients and staff.
5. Exhibits effective communication skills, including proper use of agency communication systems.
6. Participates in appropriate professional development programs to attain and maintain competency.
7. Effectively manages financial and physical resources to achieve the mission of RE.
8. Reports incidents of abuse or potential abuse involving clients to the appropriate authorities and RE.

Essential Duties and Responsibilities:

1. Assist the billing team in identifying, implementing, and monitoring projects that improve the performance of the Billing Department under the direction of the Revenue Cycle Director.
2. Performs the enrollment and credentialing process for healthcare providers and facility.
3. Submit and track applications to insurance networks and payers.
4. Ensure compliance with all regulatory and organizational requirements.
5. Communicate with providers, insurance companies, and internal teams to resolve issues.
6. Maintain accurate and up-to-date records of provider credentials and collaborate with HR to ensure a timely credentialing process for onboarding providers current provider updates.
7. Monitor the status of enrollments and follow up as needed.
8. Provide regular updates to management on enrollment progress.
9. Assist in the development and implementation of enrollment policies and procedures.
10. Process billing statements.
11. Conducts audits for each billing cycle.
12. Research and troubleshoot to ensure posting payments and rejections accuracy.
13. Respond to requests for additional information that carriers may need to determine payment.
14. Maintaining accurate medical billing records.
15. Documenting patient payments and insurance reimbursements.
16. Ensuring the insurance carriers accept the patient’s payment or claims.
17. Accept, process, and post incoming payments.
18. Reconcile receipts and make appropriate adjustments to patient accounts.
19. Download and post all incoming patient and insurance payments daily.
20. Process payments and credit balances for RE facilities as assigned.
21. Work with the Revenue Cycle Director to review each facility's Days Sales Outstanding (DSO) and ensure each facility is within the goal.
22. Post all incoming correspondence.
23. Research for possible posting errors.
24. Identify and process ICD9 and LMRP coding regulations.
25. Serve as backup for other billing processes.
26. Performs other duties as assigned.

Working conditions/environment:

1. Scheduled workdays are Monday – Friday.
2. Holidays, weekends, and extra hours may occasionally be required.
3. Environment is an office setting with extensive computer usage.
4. Maintains a positive, professional attitude, contributing to a supportive work environment.

minimum job requirements:

High School Diploma or GED required. 
An Associate’s Degree in Business, Medical Billing/Coding, or a related field is preferred. Work experience or other education may be considered in lieu of a degree.

Previous experience in medical billing/coding and provider enrollment/credentialing is required.
Previous experience preferred:

• Enrolling with RHC/FQHC.
• Working in the mental health/SUD setting.
• Troubleshooting AR denials.
• Working with claims trend analysis.
• Posting KY Medicaid wrap payments.

Must be at least 21 years of age.
Knowledge of professional fee billing for healthcare services, reimbursement, third-party payer regulation, and medical terminology is preferred. 
Knowledge of Managed Care products such as HMO, PPO, and POS.
Ability to multitask, prioritize work, and meet deadlines.
Must have excellent organizational and time management skills.
Must be able to work independently or as part of a team.
Must be detail-oriented and possess a commitment to accuracy.
Must have excellent written and verbal communication and presentation skills; focused on solving the conflict cooperatively, not blame; keeps emotions under control. 
Technical requirements include proficiency with Microsoft Word, Excel, PowerPoint, and other applications the organization or regulatory agencies use.
Ability to understand and relate to the needs of stakeholders from diverse backgrounds.
Ability to work effectively with staff, physicians, and external customers.
Ability to read, write, and converse in English.
Successful completion of a pre-employment drug screen.
Successful completion of a background screening.
Successful completion of a TB skin test or proof of a negative chest x-ray or other documentation.

Successful completion of Excellent Foundations.
Maintain 20 hours of annual training.
Basic Electronic Medical Record (EMR) system training.

Physical Requirements:

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
While performing the duties of this job, the employee is regularly required to stand, walk, talk, hear, and smell.  The employee frequently is required to sit; use hands to finger, handle, or feel; reach with hands and arms; and stoop, kneel, crouch, and climb stairs.  The employee is occasionally required to climb, balance or run.  The employee must frequently lift and/or move up to 10 pounds or more.  Specific vision abilities required by this job include close vision, distance vision, and peripheral vision. 

Supervisory REquirements:

N/A

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