Credentialing Specialist

Base Pay Range:$22.00 - $33.00Job Description:The Payor Enrollment Specialist/Insurance Specialist is a Full Time, Regular position working Monday-Friday 7am-4pm, but hours can be flexible. This is hybrid position after training working in at home 3 days per week and 2 days in office Downtown Spokane.Summary: The primary responsibility of the Payer Enrollment Specialist / Insurance Specialist is payer enrollment and maintenance for Inland Imaging organizations, including facilities and practitioners. This position manages the payer enrollment lifecycle, including new enrollments, revalidations, updates, location enrollments, payer correspondence, application tracking, and follow-up with payers to ensure providers and facilities are appropriately enrolled and claims can be submitted and reimbursed timely.As a secondary responsibility, this position works insurance denials and claim issues specifically related to payer enrollment, including researching enrollment-related denials, identifying the root cause, coordinating corrections, and working with internal teams and payers to resolve issues and prevent future denials.The position requires a high level of accuracy, organization, follow-through, confidentiality, and the ability to manage multiple payer enrollment requirements and deadlines simultaneously.General Description: Performs payer enrollment functions for all Inland Imaging organizations, including completing and maintaining payer enrollments for practitioners and facilities; gathering required documentation; completing paper and electronic applications; monitoring enrollment status; maintaining enrollment records and matrices; coordinating provider and location enrollments; completing revalidations and updates; and communicating with payers and internal departments to ensure enrollment requirements are met timely and accurately.As a secondary function, performs insurance denial and claim follow-up related to payer enrollment issues. This includes researching enrollment-related denials, determining the cause of the denial, correcting enrollment information, coordinating with credentialing and other internal teams, submitting corrected claims or appeals when appropriate, and tracking issues to resolution.Essential Duties/Responsibilities: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.Gathers forms and data requirements from individual payors and compiles documents.Completes all paper and on-line forms and disseminates forms to the physicians with the appropriate instructions.Reviews all returned forms for accuracy and completeness.Maintains the enrollment matrix.Prepares and disseminates correspondence.Sends applications and enrollments to individual payors; follows through with payors and team in a timely manner to procure proper enrollments.Interprets enrollment regulations accurately and in keeping with federal, state, and third-party billing regulations and policies.Prioritizes outstanding enrollments appropriately.Coordinates new physician enrollments with the credentialing coordinator.Enrolls new locations with payors in a timely manner.Works with the RBS team on credentialing denial investigations and timely follow-up.Reviews unpaid claims by calling for payment status, appealing denials, and correcting and resubmitting claims when necessary.Follows up with insurance companies for any unpaid or incorrectly paid services provided to patients.Helps patients with collection questions when a Collections Specialist is not available.Writes off uncollectible balances with dollar values as high as $500 (dependent on experience).Resolves claim edits (missing claim information) prior to submission of the claim to insurance companies.Reviews appropriateness of and processes refunds for all payers as appropriate.Works with vendors to resolve payer issues.Corrects posting discrepancies to reflect the payor's adjudication advice.Researches payments received but not yet posted.Attends monthly meetings to stay up to date with new policies and upcoming changes and communicates them to leadership.Works closely with referring physician offices to obtain retroactive authorizations or referral numbers.Trains with peers and performs peer-to-peer QA.Supports the LLC staff to provide eligibility status for patients on site.Timeliness and accuracy are paramount in this role.Other special projects and duties as assigned.General Duties and Responsibilities:Ability to maintain strict confidentiality within the Inland Imaging companies and Inland's customers.Follows all Health and Safety policies and guidelines of Inland Imaging or its partners depending on work location.Follows all company policies including those regarding harassment, non-retaliation, discrimination, respectful workplace, and related policies.Follows all policies regarding HIPAA, non-disclosure of confidential information, and company security.Honest, pleasant manner and good personal hygiene.Free of alcohol and drug abuse.Ability to access multiple worksites in a timely manner.Excellent communication and interpersonal skills.Detail oriented; ability to multi-task; organized and able to work in a fast-paced environment.Demonstrates self-directed learning and participation in continuing education through professional journals, approved seminars, etc.Ability to consider individual needs in communication with and assessment and treatment of patients of all ages.Adheres to departmental standards and personnel policies by demonstrating professional demeanor in conduct and appearance.Follows company departmental standards and personnel policies by using good teamwork and communication skills to help identify concerns and solutions, assisting where needed to ensure a smooth functioning department.Performs other duties as required by displaying team spirit and self-growth, accepting and performing other projects and responsibilities, and requesting other projects and responsibilities.Attendance is a requirement for this position.Rotates to other shifts and locations as needed.Performs other special projects and duties as assigned.Supervisory Responsibilities: There is little or no supervisory responsibility in this position.Advocacy:Treats all clients with dignity and respectProvides excellent customer serviceConforms to Joint Commission and HIPAA regulationsComplies with PHI (Protected Health Information)Demonstrates the Inland Imaging Core Values: Show We Care, Do The Right Thing, Maximize Individual Potential, Challenge ConventionQualifications:Education: High School Diploma/GED required. One- to two-year medical billing course is required.Experience: Patient accounts billing experience is desired. At least two years of experience in billing requirements for either government or commercial insurers, or experience in provider enrollment, required. Familiarity and experience with Washington's One Health Port, Echo One, DocuSign, and individual payor websites; CAQH and Medicare PECOS provider enrollment systems is a plus. Working knowledge of Medinformatix or other patient accounting systems preferred. CPT and ICD-10 coding experience preferred. Good customer service skills.Licensure: N/ACertifications: Credentialing certification is desired.Computer Skills: Microsoft Office Suite (Outlook, Word, Excel), Workday, Webex, Internet/Intranet, Meditech, Code Correct, Medinformatix, Waystar.Background Check: Must be able to pass a background check required by RCW View phone number on click.appcast.io to work with children under the age of 16, developmentally disabled persons, or vulnerable adults. In order to comply with provisions set forth in Sections 1128 and 1156 of the Social Security Act, all new employees of Inland Imaging Business Associates will be checked against the LIST OF EXCLUDED INDIVIDUALS provided by the Department of Health & Human Services, Office of the Inspector General (OIG). Employees must not be included on this list.Drug Test: Eligible employees must be able to pass a post-offer, pre-employment drug test.Remote Work: Ability to work from a remote location (home) under a hybrid model. Required to have a dedicated area to perform the job that is private and has a desk, chair, appropriate lighting, and access to internet.Nuvodia/Inland is an EEO employer... #J-18808-Ljbffr