Provider Enrollment/Billing Specialist - NOT REMOTE

Peninsula Community Health Services of Alaska•Soldotna, AK

10d•Onsite

About The Position

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.

Requirements

High School Graduate.
3-5 years of healthcare claims processing and/or billing/coding experience preferred.
Must pass a State required background check plus a pre-hire drug screen.

Nice To Haves

Certified Medical Coder (AAPC or AHIMA) preferred but not required.
FQHC experience preferred but not required.
Willing to train the right candidate.

Responsibilities

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 PPO’s 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 PPO’s 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.