Medical Billing Associate, Credentialing Spec

Job Description

Job Description

Mission

The Warren Center advocates, serves and empowers the children and families impacted by developmental delays and disabilities.

Core Values

Demonstrate The Warren Center’s Core Values:

• We are family focused and work passionately for our families.
• We play well with others , we have fun, find joy and love a good laugh while treating everyone with respect, courtesy and honesty.
• We are curious , we ask why and we seek to understand, to learn and to grow.
• We are solution driven , when we see an issue, we speak up, act and don’t rest until solutions work efficiently and well.

Summary

Reporting directly to the Chief Operating Officer, the Medical Billing Associate – Credentialing Specialist supports the overall mission of The Warren Center by ensuring the agency and therapists are properly enrolled and compliant with insurance payers, managing applications, licenses, renewals and re-attestations.

Essential Duties and Responsibilities

To perform this job successfully, an individual must be able to perform the following satisfactorily.

• Compiling and Maintaining records of licenses, credentials, and insurance contracts
• Advising staff on renewal procedures
• Completing and submitting new provider enrollment applications required for Medicaid, and commercial payers
• Conducting primary source verification (licenses, education, certifications)
• Managing re-credentialing and license/certification renewal deadlines
• Ensuring compliance with regulatory standards
• Preparing reports required by regulatory and accrediting agencies
• Communicating clearly with providers, their liaisons, and/or representatives
• Capturing primary source documentation in computer databases
  
• Liaising with providers, payers, and internal departments.
  
• Ensure that all internal and external customers are treated with respect, provide knowledgeable answers, and a welcoming attitude
• Responsible for data entry and maintaining provider information in online credentialing databases and systems such as NPPES, CAQH, and TMHP
• Audits applications for accuracy and completeness
  
• Responsible for revalidation requests issued by payers
  
• Responsible for monitoring application progress and following up with payers as needed until confirmation of “in network” status has been received
• Tracking all required documentation and expiration dates, insurance re-attestation dates, etc. and ensuring that all is current and submitted in a timely manner to appropriate entities
• Utilizes strong research skills to gather pertinent information regarding providers
• Other duties as assigned

Education and Experience

• Required: High school diploma or General Educational Development (GED) diploma
• Required: 3+ experience in medical billing with focus on credentialing and recredentialing requirements

Additional Technical Skills, Traits and Knowledge

To perform this job successfully, an individual must be able to perform each qualification satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

• High energy and passion for The Warren Center’s mission is essential
• Maintain high level of confidentiality with personnel information
• Flexible and adaptable style
• Clear and concise communication skills
• Professional, dependable, and proactive
• Ability to work both independently without close oversight, and also as a team player who will productively engage with others at varying levels of seniority within and outside The Warren Center
• Strong organizational and time management skills with exceptional attention to detail
• Advanced knowledge of Microsoft Office Suite: including Word, Excel, Outlook, SharePoint/OneDrive, and Teams
• Good finger dexterity
• Good vision

Environment

The physical requirements and work environment characteristics described here are representative of those employee encounters while performing the essential functions of this job. Reasonable accommodation will be provided to enable individuals with disabilities to perform the essential functions of the job.

• Frequently required to use hands to write and use keyboard as well as see, talk and hear
• Occasionally required to stand and move around for work
• Moderate stress level
• Long periods of sitting
• The noise level in the work environment is usually moderate in a shared workspace

E QUAL O PPORTUNITY E MPLOYER

The Warren Center is an Equal Opportunity Employer, and we believe in an inclusive culture for all. The Warren Center provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.