Billing/Payer Enrollment Specialist (62781)

Job DetailsJob Location: Administration - Lancaster, PA 17602Our Mission, Vision, & Model of Care

At Union Community Care, our purpose is at the forefront of all that we do: we stand for whole health to help you live your fullest life.

We envision vibrant and healthy communities supported by inclusive healthcare that embraces each member’s unique culture, needs, and values, and emboldens them to make healthful choices that fuel their well-being and the well-being of others.

We believe in whole health. This means we address and heal disease but equally important, we work at the causes of the causes, the social ills that must be addressed to achieve true equity.

We listen, learn, and embrace the complex lives and unique strengths of our patients, and we work hard to break down all barriers to care. This means we look through a grassroots lens. We connect with our communities because we are our communities. Each of us is a neighbor, a friend, a family member, and together, we are a trusted community health center.QualificationsJob Duties:

Completing all initial payer enrollment applications for commercial and government payers and completing timely follow up.
Completing and maintaining all CAQH profiles for all providers
Ensuring that re-credentialing and revalidations are completed timely to prevent any lapse in enrollment
Maintenance of credentialing and billing information in the Credentialing enrollment system
Communicating with payers, providers, and other entities to quickly and accurately obtain or provide information beneficial to the credentialing or enrollment needs of the organization
Maintaining knowledge of current health plan and agency requirements for credentialing
Ensuring practice addresses are current with government and commercial health plans, agencies and other entities
Maintaining confidentiality of provider information
Terminating enrollment with government and commercial payers upon resignation or termination of providers
Updating and maintaining National Provider Identification files for locations
Using the electronic billing system, along with any of the organization’s proprietary spreadsheets or software, purchased or leased, as the primary source of immediate notification and maintenance of enrollment related data
Responding to the enrollment services dashboard tasks and overall maintenance and content
Communicating with Athena Health Enrollment Services as needed both verbally or through tasks and cases
Monitoring worklists to identify increases in accounts receivable or claims denials related to enrollment and credentialing issues, and working toward resolution
Collaborate with Billing Specialist on any issues related to payer enrollment.
Processes and posts insurance payments along with patient payments in an accurate and timely manner in accordance with Union Community Care’s policies, procedures and performance goals.
Coordinates with PAS to ensure accurate patient information for billing purposes
Performs a variety of general clerical duties, including telephone reception, mail distribution, and other routine functions.
Works Claim Holds and Denials by investigating (calling), correcting and resubmitting claims to third party payers
Answers questions from team members, patients and insurance companies
Maintains patient demographic information, including insurance eligibility and benefit verification
Participates in educational activities and attends staff meetings
Maintains strict confidentiality and adheres to all HIPAA guidelines and regulations
Performs other work-related duties as assigned

SPECIFIC JOB DUTIES- Billing Team Lead

Performs all duties of Billing/Payer Enrollment Specialist
Works with Billing Specialists to research appropriate billing & coding procedures
Works with Director of Billing to maximize revenue potential based on our unique services and providers
Works with Director of Billing to maximize department efficiency
Assists with reconciliation errors
Works with Accounting to identify any discrepancies in cash
Keeps ongoing knowledge of current CPT/CDT guidelines and educates Billing Specialists

Responsible for Training of Billing Staff

Assists with Training of PAS

Certification in Medical Billing or Coding preferred

Qualifications, Skills and Knowledge Required

3 years minimum experience in a payer enrollment related field
Knowledge and thorough understanding of managed care operations including enrollment, credentialing, contracting and claims
Knowledge of payer processes, local, state, and federal requirements
Excellent written and oral communication skills
Strong organizational, problem solving and decision-making skills
Ability to prioritize and manage multiple projects and issues effectively and simultaneously
Self-motivated and self-starter who can work well under minimal supervision
Strong attention to detail, research and follow up skills
Knowledge of medical terminology and current CPT OR CDT coding practices preferred
Working knowledge of Microsoft Office, EMR software’s and other online programs; along with general business equipment
Basic mathematic skills
Spanish proficiency preferred
Ability to work well with others

ESSENTIAL FUNCTIONS

To fulfill the requirements of this position, all duties are considered essential functions of the job.

ORGANIZATIONAL INVOLVEMENT

This position is required to participate in mandatory all staff meetings, team meetings and trainings.