Job Details

Fqhc Billing/Credentialing Specialist

Knowledge, Skills, and Abilities

• Responsible for timeliness of provider enrollment with necessary payors.
• Create and maintain accurate records of all enrollments for all CFHC locations and providers.
• Prepares and submits clean claims to third party payers either electronically or by paper.
• Follows billing guidelines and legal requirements to ensure compliance with federal and state regulations.
• Respond to account inquiries from patients, payers, providers, and/or other staff as requested.
• Identifies and resolves patient/insurance billing issues.
• Work closely with team members regarding claim appeals, denials, resolution, and education.
• Performs and monitors all steps in the billing processes to ensure maximum reimbursement from patients, government, and commercial payers as well as from special billing arrangements.
• Understands Medicare, Medicaid and other commercial payer rules and regulations applicable to billing. Updates business office staff, clinics, residents, and faculty of changes as appropriate.
• Responsible for ensuring all providers are oriented to coding, billing, and documentation compliance.
• Responsible for the continuing coding, billing, and documentation education for all providers and residents.
• Understands the considerations of coding in Value Based payment contracts.
• Responsible for reviewing and implementing changes from payer bulletins.
• Use online healthcare databases and other resources for verification and claim status.
• Deliver the highest quality service to internal and external customers.
• Assist other members of the team with projects as needed.
• Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
• Other duties as assigned by management.

Qualifications/Education Requirements

• High school diploma or GED certificate required. 2 years experience in physician credentialing and provider enrollment. 2 years in FQHC billing or 5 or more years in physician or hospital billing of accounts receivable. Experience in medical billing/coding preferred. Excellent computer skills and a familiarity with ADA, CPT, and ICD-10 coding is required. Certified Professional coder (CPC) certification desired.

Core Competencies

• Competent in both oral and written English.
• Read and interpret policies and procedures.
• Processes and posts accounts receivable payments to patient accounts.
• Posts insurance payments and adjustments for medical, dental, behavioral health, and optometry claims accurately and on schedule.
• Reconciles transaction activity.
• Reviews private insurance claims for accuracy prior to submission to payers for payment.
• Processes claims to payers in a timely manner.
• Works denied claims by correcting and resubmitting claims to payers in a timely manner.
• Assists with provider and location credentialing.
• Provides technical and billing assistance to clinic staff as needed.
• Communicates with staff, patients, and intermediaries.
• Assists HIT Trainers with electronic practice management and billing requests.
• Performs other duties as requested or required.
• Competent in basic computer skills, including spreadsheets and business letters.
• Competent in basic math, including calculation of ratios and percentages.
• Upholds, complies with, and enforces the Core Principles and Code of Conduct