Credentialing Specialist, Bureau of Revenue

Credentialing Specialist, Bureau of RevenueThe Bureau of Revenue is responsible for collecting $1.3 billion of revenue generated around the city of New York. The patient billing unit with a target goal of $4k, is responsible for fulfilling New York State Article 6 requirements to do due diligence by collecting insurance information from patients who are insured to bill third party payers for reimbursements to offset cost of providing care to the uninsured or under insured. The Patient billing unit continuously manages, develops and implements policies that support the values, vision and mission of the agency. Position Summary: Reporting to the Director of Patient Billing, the Credentialing Specialist will be responsible for the verification of all new and existing clinical provider's qualifications to ensure that they meet legal regulatory standards for patient care, and organizational tasks to promote the financial health of the revenue stream. Applicants must be detailed oriented and must have a working knowledge of credentialing in the healthcare industry. Job Duties and Responsibilities: - Verification of Credentials - Reviews professional licenses, medical education, training, and certification (e.g. board certification, DEA registration). - Provider Enrollment - Coordinates enrollment with insurance networks (e.g., Medicare, Medicaid, and commercial plans) to ensure providers are in network to be eligible for reimbursement. - Database Management - Maintain up-to-date provider profile in databases like CAQH Proview, PECOS, and NPPES. - Compliance Monitoring - Tracks expiration dates for licenses, health plan revalidations, and proactively initiating ETIN renewals to prevent revenue disruptions. - Meet with clinical team - on or offsite clinic visits with providers to complete annual ETIN and onboarding applications. - Update Billing Data Bases - Update billing system with provider billing credentials to facilitate billing. - Assist Billing Team - perform third-party billing and collection activities within the billing system(s) when assigned. Preferred Skills: - Bachelor's degree or higher from an accredited college or university. - Minimum of 2-3 years' experience as a credentialing specialist in a healthcare organization. - Experience with Article 28, 31, and 36 clinic billing Preferred. - Experience in the various NY State and Federal Credentialing systems, e.g. NPPES and PECOS - Familiar with Managed Care (MCO) contracting and enrollment process. - Knowledge of third-party reimbursements and adjudication process. - Ability to multi-task and perform accounting computations is required. - Knowledge of Medical billing and coding +plus - Ability to communicate effectively with staff and other stakeholders across the agency. - Extreme attention to detail, strong communication for interacting with providers and health payers and the ability to handle confidential HIPAA-protected data. Proficiency in Microsoft office (Excel/Word). - Excellent customer service and interpersonal skills. Excellent problem solving and critical thinking skills. In-depth knowledge of industry best practices. Ability to work independently, collaborate with others, multitask, and a team player.