Insurance Credentialing

Sullivan County Community Hospital•Sullivan, IN

About The Position

QUALIFICATIONS Education High school graduate or equivalent Experience/Skills Possesses knowledge of business office operations Understands third party billing requirements Understands Medicare/Medicaid inpatient and outpatient billing Strives for customer satisfaction when responding to all patient/customer inquires (internal customers) Experience using office equipment Adapts professionally to changes in procedures and/or workload Possesses excellent written and oral communication skills Works independently with little supervision Maintains concentration Remains committed to a “cross training” philosophy for all assigned tasks Required Licenses/Certifications N/A Working Conditions Works in a well-ventilated, well-lit general office environment Works well under pressure with attention to time constraints

Requirements

High school graduate or equivalent
Possesses knowledge of business office operations
Understands third party billing requirements
Understands Medicare/Medicaid inpatient and outpatient billing
Strives for customer satisfaction when responding to all patient/customer inquires (internal customers)
Experience using office equipment
Adapts professionally to changes in procedures and/or workload
Possesses excellent written and oral communication skills
Works independently with little supervision
Maintains concentration
Remains committed to a “cross training” philosophy for all assigned tasks

Responsibilities

Reviews, identifies, and corrects claims issues identified in claim scrubbing holds
Sends clean, timely claims out on first billing
Works Athena claim/biller holds to ensure that upfront rejection of claims are worked and resubmitted to correct payer
Provides support to physician billing phone lines daily
Reviews assigned outstanding accounts receivable by using hold buckets, queues, and outstanding AR reports
Submits timely and accurate adjustments documenting activity within account
Follows up with insurance companies to ensure claims are processed and paid correctly according to contract
Understands and manages denials, submitting timely disputes and appeals
Understands payer contracts and billing guidelines, revenue codes, cpt codes, modifiers, and payor-specific guidelines
Obtains, completes accurately, and submits timely commercial payers and Managed Care entities enrollment applications for providers
Revalidates providers with contracted payers
Links new providers to existing contracts
Maintains provider payer information in Credentialing folder
Investigates and reports claim denial trends with payer documentation for department to review and to put action plan in place