Credentialing and Enrollment Coordinator/Billing Specialist-Remote

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About the position

The Credentialing and Enrollment Coordinator/Billing Specialist will be responsible for efficiently managing enrollments, re-credentialing, and new contract applications with various commercial and government health plans on behalf of Saint Francis Ministries. This position also performs coding review, billing, payment posting, aging, and denial follow up for the Revenue Operations Department. The position is responsible for processing claims and payments into our Electronic Health Records (EHR) Practice Management Systems (PMS) and legacy system platforms.

Responsibilities

  • Manage enrollments, re-credentialing, and new contract applications with various commercial and government health plans
  • Understanding of third-party payer guidelines and requirements
  • Proactively follow up on application progress and ensure timely completion
  • Communicate contracting and enrollment process effectively to clients and internal stakeholders
  • Handle CAQH maintenance for providers
  • Manage clearinghouse setup and enrollments
  • Safeguard insurance website and clearinghouse access credentials
  • Maintain accurate records and databases related to provider credentialing, contracts, and network development activities
  • Collaborate with internal teams to communicate and coordinate network changes, updates, and issues
  • Serve as a liaison between the organization and Insurance
  • Billing and management of claims for multiple programs and payers to achieve maximum reimbursement
  • Reviewing claims for accuracy
  • Reduce rejections and denials by scrubbing claims for timely and accurate submission
  • Resolve denial instances
  • Ability to work aging and contact payers and state programs for timely payment
  • Identifying and billing secondary and tertiary insurances
  • Payment posting into PMS and legacy system
  • Prepare Excel worksheets and reports as applicable.
  • Prepare or assist in preparing financial reports and projects

Requirements

  • High School diploma or equivalent.
  • Minimum of three years of Insurance credentialing and enrollment experience
  • Minimum of two years of billing experience in a healthcare setting, behavioral health preferred.
  • Must be 21 years of age.
  • Must have a valid Driver's License.
  • Must pass a drug screen, MVR, and Child Abuse and Neglect Central Registry clearance check.
  • Lifting Requirements of 30-50 lbs.
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