American Tele-Physicians, a USA based leading firm in innovative healthcare technology is looking for experienced Credentialing Specialist for medical biller role.
Key responsibilities in this role would be:
- The ideal candidate will have a strong background in medical billing and credentialing and possess knowledge of medical terminologies
- Experience with medical and professional credentialing processes, policies and procedures, including delegated credentialing requirements.
- Ensure to verify that the credentials of health care professionals are in compliance with state and federal standards.
- Demonstrated understanding of healthcare billing and commercial insurances.
- The candidate will be responsible for maintaining active status for all providers by successfully completing initial and subsequent credentialing packages as required by hospitals, surgery centers, commercial payers, Medicare and Medicaid.
- Credential new providers and re-credential current providers with hospitals at which they hold staff privileges.
- Work closely with the Revenue Cycle Director and billing staff to identify and resolve any denials or authorization issues related to provider credentialing.
- Obtaining referrals and pre-authorizations as required for procedures.
- Checking eligibility and benefits verification for treatments, hospitalizations, and procedures.
- Reviewing patient bills for accuracy and completeness, and obtaining any missing information.
- Preparing, reviewing, and transmitting claims using billing software, including electronic and paper claim processing.
- Following up on unpaid claims within standard billing cycle timeframe.
- Checking each insurance payment for accuracy and compliance with contract discount.
- Calling insurance companies regarding any discrepancy in payments if necessary
- Identifying and billing secondary or tertiary insurances.
- Reviewing accounts for insurance of patient follow-up.
- Researching and appealing denied claims.
- Answering all patient or insurance telephone inquiries pertaining to assigned accounts.
- Setting up patient payment plans and work collection accounts.
- Updating billing software with rate changes.
- Updating cash spreadsheets, and running collection reports.
Education and Experience
- Bachelor’s degree in Business, Health Care Administration, Accounting or relevant field.
- A minimum of 3 years of experience as a Medical Biller or similar role.
- Solid understanding of billing software and electronic medical records.
- Must have the ability to multitask and manage time effectively.
- Excellent written and verbal communication skills.
- Outstanding problem-solving and organizational abilities.
- Excellent computer skills including Excel, Word, and Internet use
- Plans and prioritizes to meet deadlines
- Excellent customer service skills for effective and engaging communications