About the job Medical Billing Specialist
Position Title: Medical Billing Specialist
Reports To: Partner, Partner Advisor
Primary Relationships: Partner Team
Date: September 2024
Schedule: 8:30 PM - 5:30 AM PHT
Summary:
We are seeking a highly organized and detail-oriented Credentialing Specialist with experience managing provider credentialing, particularly in the mental health sector. The ideal candidate will ensure that providers are accredited and able to bill for services under various insurance plans, including Medicaid, Medicare, Managed Care Plans, Commercial Plans, and Behavioral Health carve-outs.
Responsibilities:
Oversee the credentialing process for providers, ensuring accreditation with Medicaid, Medicare, Managed Care Plans, Commercial Plans, and Behavioral Health carve-outs
Collect necessary documentation, submit applications, and manage recredentialing deadlines
Coordinate with insurance companies and state-specific plans to confirm provider credentialing
Ensure that providers maintain active credentials and can bill for services
Keep detailed records of each provider’s credentialing progress using spreadsheets, databases, or other credentialing tools
Monitor credentialing and recredentialing deadlines to avoid interruptions in service
Address any credentialing issues, such as delays or missing documentation, to keep the process moving efficiently
Resolve discrepancies between providers and insurance plans as they arise
Ensure credentialing compliance with state and plan-specific requirements, including Medicaid and Medicare
Knowledge of New York State regulations is preferred but not required
Regularly update providers on the status of their credentialing and follow up to collect any necessary documentation promptly
Qualifications:
Proven experience in provider credentialing, particularly with Medicaid, Medicare, and Commercial Plans
Strong organizational skills and the ability to manage multiple credentialing tasks simultaneously
Excellent communication and problem-solving skills
Familiarity with credentialing software, spreadsheets, or other tools for managing applications
Knowledge of New York State regulations is preferred but not required
Experience with credentialing in the mental health or behavioral health fields is an advantage