Job Summary

The Credentialing and Billing Specialist is responsible for maintaining active status for all clinicians and physicians by successfully completing the initial and subsequent credential packages as required by regulatory agencies, commercial payors, and Medicaid and Medicare. This includes ensuring that all clinical staff have the necessary qualifications for their position and that the payor enrollment process is complete for participation. The Credentialing and Billing Specialist is also responsible for executing any designated tasks of the billing department.

Essential Responsibilities and Metrics

Serves as the credentialing point of contact for all clinicians.

Completes credentialing applications to add clinicians and providers to commercial payors, Medicare, and Medicaid within established timeframes.

Completes re-credentialing applications for commercial payors within established timeframes.

Maintains individual clinician files to include up-to-date information needed to complete the required governmental and commercial payor credentialing applications.

Maintains the credentialing software and tracking system to ensure that it is current for all clinicians.

Performs verification and authorization with multiple insurance companies ensuring that the appropriate criteria was followed and documentation is complete for contracts and renewals.

Assists with clinician onboarding and renewals to ensure that all required documents are received for credentialing.

Establishes staff EMR accounts during onboarding and ensures that staff licensing data is accurately entered.

Works with payors to credential and re-credential clinicians and resolve any denials or authorization issues related to provider credentialing in a timely manner.

Notifies billing staff of all credentialing and payor updates.

Maintains confidentiality of credentialing information.

Works with the Revenue Cycle Manager, Billing staff, and Talent and Culture staff to support the credentialing and re-credentialing process of clinical staff.

Other responsibilities and special projects as assigned.

Qualifications

Bachelors degree or related field or equivalent experience

Knowledge of provider credentialing and its direct impact on the practice's revenue cycle

Minimum of 3 years progressive experience in credentialing, behavioral healthcare billing; both Medicaid, Medicare, and MCOs and commercial payers; behavioral health preferred

Proficient in billing software and Office 365 Suite; CIS experience preferred

Sound knowledge of health insurance providers

Detail oriented with above average organizational skills

Strong interpersonal and organizational skills

Excellent customer service skills; communicates clearly and effectively

Ability to work in a fast-paced environment and plans and prioritizes to meet deadlines