Medical Staff Credentialing and Billing Specialist

General Summary of Duties: The Credentialing and Billing Specialist is responsible for the submission of billings. Additional, this position is responsible for all aspects of the credentialing and re-credentialing processes for all providers, at Kitsap Mental Health Services.

Major Responsibilities/Tasks:
  • The Credentialing and Billing Specialist is responsible for the submission of billings and the posting of payments received.
  • This role also serves as an auditor, ensuring that the billing statements are accurate and received payments.
  • Reviews patient's bills for accuracy and completeness; obtaining missing information
  • Review electronic claims to ensure timely payment, adjust electronic claims in response to error messages, and timely follow-up; send additional information as requested
  • Review denials or partially paid claims and work with the involved parties to resolve the discrepancy.
  • Communicate with health care providers, patients, insurance claim representatives, and other parties to clarify billing issues and facilitate timely payment.
  • Consult supervisor, team members, and appropriate resources to solve billing and collection questions and issues.
  • Perform a variety of administrative duties including but not limited to: answering phones; faxing and filing confidential documents; and basic Internet and email utilization.
  • Review and understand correspondence received from third-party payers. Adhere to all established performance goals and account for any performance variances
  • Additionally, this position is responsible for all aspects of the credentialing and re-credentialing processes for all providers at KMHS locations.
  • Compiles maintains and audits credentialing records for current and accurate data for all providers
  • Ensure providers' information is up -to-date in all appropriate online systems, and ensure that all federal and state guidelines are met
  • Completes and processes provider credentialing and re-credentialing applications for all contracted health plans and follows up as needed
  • Verifies Human Resources maintains current copies of all provider documentation including state licenses, malpractice coverage , certifications, etc.
  • Responsible for tracking CME requirements, as well as expiration dates of provider licenses and certifications. All expiration dates must be properly calendared, allowing for adequate time to ensure timely renewals
  • Coordinate with appropriate departments the timely onboarding and off-boarding of all clinician staff.
  • Maintains knowledge of current health plan and agency requirements for credentialing providers.
  • Create and maintain contract records including original documents, correspondence, key documents in paper files, and the contract file database; provide timely and accurate data to practice management system
  • Documents procedures and workflow for credentialing processes.
  • Research issues related to claims payment and requests for reconsideration.
  • Assures the ongoing development, drafting, and implementation of credentialing policies and procedures that guide and support the goals of Kitsap Mental Health Services.
  • Works directly with the Chief Financial Officer and key staff in the Revenue Cycle process to create and implement new workflows and tools
  • Maintains strictest confidentiality; adheres to all HIPAA guidelines / regulations
  • Other duties as assigned by the supervisor

KMHS is an equal opportunity employer that does not discriminate against people regardless of age, genetic information, national origin, race/color, ethnicity, gender identity, sexual orientation, neurodiversity, disability, or veteran status. KMHS envisions an anti-racist, equitable, inclusive, and collaborative community in which all can feel welcome.

Benefits:
  • Comprehensive and generous health, dental and vision benefits
  • Up to 19 days of PTO and 8 paid holidays your first year (pro-rated for part-time)
  • An incredible team approach that is dynamic and collaborative
  • Loan Forgiveness, training, and extensive education available
  • Multiple locations and opportunities close to home
  • Advancement opportunities available within the agency
  • Free Employee Assistance Program and parking
  • Full Time, Part Time and PRN positions along with flexible hours for professional advancement


Qualifications

Minimum Qualifications:

EDUCATION: High School Diploma or GED

EXPERIENCE: Experience using an Electronic Medical Record (EMR)

Knowledge of insurance billing and collection principles, problem-solving abilities, customer service orientation, and ability to effectively communicate.

Preferred Qualifications:

EXPERIENCE:

Trained and active or working to achieve Certified Professional Coder (CPC) license is encouraged

Knowledge of insurance billing and collection principles, problem-solving abilities, customer service orientation, and ability to effectively communicate.

Experience with computerized accounting systems and proficiency with PCs and associated software applications.

Experience in reading/understanding of remittance advices, Explanation of Benefits, and denial letters.