RCM Specialist Full Time NEW

About The Position

Requirements

• At least 2 years’ experience in medical billing
• Knowledge of the credentialing process for health care providers is mandatory
• Bachelor’s Degree. Will consider non-degreed candidates with significant relevant experience of at least 2 years with hands on credentialing of providers.
• Extensive familiarity with insurance carriers’ credentialing requirements.
• Computer literate (Excel, Nitro, Access) with a willingness and ability to learn new applications.
• Knowledge of Credentialing databases and other software programs to include CAQH, NPDB, ePREP, NPPES and PECOS.
• Knowledge of EHR esp. Nextgen.
• Experience with checking provider status in various databases, such as NPPES, CDS, DEA, OIG, Medicare, NPDB, etc.
• Excellent oral communication skills with ability to hear and to speak standard English clearly and concisely.
• Excellent written communication skills with ability to read, write and spell standard English clearly and concisely.
• Ability to interact effectively with culturally diverse patient, practitioner, and employee population.
• Ability to convey a positive attitude and project a professional image.
• Ability to remain flexible and maintain confidentiality.
• Possesses excellent time management skills.
• Requires long periods of sitting, intermittent standing, reaching, and bending.
• Ability to maintain reliable attendance.

Nice To Haves

• CPCS certification preferred.

Responsibilities

• Obtain eligibility and authorizations for services.
• Contact payers for claim status and general inquiries.
• Follow up on claim denials.
• Create encounters and enter charges for various services including cardiac interrogations, home health and hospital visits.
• Answers emails and billing related tasks in a timely manner according to company protocol.
• Writes appeals/ Scans Documents
• Perform all duties related to credentialing/re-credentialing and enrollment of payors for initial and current providers.
• Provide credentialing application to all newly hired providers, assist with completion of all applications, and needed documents with timely return for processing.
• Perform all duties related to provider departure including notification to payors and hospitals.
• Verify all credentials and malpractice claims through the state licensing board and other PSV sources.
• On an ongoing basis, remind providers when licenses require renewal.
• Assure applications are processed within a thirty-day processing time frame.
• Prepare file for presentation to the MAC of Clinical Associates for disposition.
• Coordinate all credentialing-related appointments with the hospital.
• Facilitate the reappointment process for hospital privileges.
• Maintain/update physical credentialing files for each provider.
• Maintain all credentialing databases such as CAQH, NPDB, NPPES, PECOS, ePREP and other identified databases.
• Act as liaison between administrative staff of Clinical Associates and the payors in resolving credentialing issues for physicians.
• Request malpractice insurance for newly hired providers as appropriate.
• Request claims history from malpractice company as needed.
• Perform all administrative duties as related to renewal of malpractice insurance for the company.
• Process tail coverage for all departing providers following policies of the malpractice insurance company and Clinical Associates.
• Provide copies of malpractice face sheets to appropriate entities as needed.
• Initiate and renegotiate MCOs and small to medium commercial payor contracts for Clinical Associates.

Benefits

• PTO
• Medical, vision and dental benefits
• Life Insurance
• Long Term Disability
• Paid Holidays
• 401K