Insurance Credentialing at Sullivan County Community Hospital

Sullivan, Indiana, United States -

Full Time

Start Date

Immediate

Expiry Date

13 Apr, 26

Salary

0.0

Posted On

13 Jan, 26

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Business Office Operations, Third Party Billing, Medicare Billing, Medicaid Billing, Customer Satisfaction, Office Equipment, Adaptability, Written Communication, Oral Communication, Independence, Concentration, Cross Training, Claims Management, Denial Management, Provider Enrollment, Payer Contracts

Industry

Hospitals and Health Care

Description

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 ROUTINE RESPONSIBILITIES Behavioral Expectations * Consistently complies with established Behavioral Expectations Essential Duties * 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 Full Time/Day Shift 80 hours/Bi-weekly

Responsibilities

The role involves reviewing and correcting claims issues, ensuring timely submission of claims, and providing support for physician billing. Additionally, it includes managing denials and maintaining provider payer information.