Medical Billing and Credentialing Expert

Job Summary:

We are seeking an experienced Athena Billing and Credentialing Expert to manage and optimize our revenue cycle operations. The ideal candidate will have in-depth knowledge of Athenahealth's billing and credentialing processes, ensuring accurate claims submission, timely reimbursements, and provider enrollment. This role requires strong analytical skills, problem-solving abilities, and a deep understanding of medical billing, coding, and insurance verification.

Key Responsibilities:

Billing & Revenue Cycle Management:

• Manage end-to-end Athenahealth billing processes, including charge entry, claims submission, payment posting, and accounts receivable follow-up.
• Identify and resolve claim denials, rejections, and underpayments to maximize reimbursements.
• Conduct audits and analyze revenue cycle performance to improve efficiency.
• Ensure compliance with HIPAA, CMS, and payer regulations.
• Work with clinical teams to streamline coding and documentation processes.

Credentialing & Provider Enrollment:

• Handle provider credentialing, re-credentialing, and enrollments with insurance payers, Medicare, and Medicaid.
• Maintain up-to-date records for provider contracts, CAQH profiles, and NPI registrations.
• Track expirations and proactively renew licenses, certifications, and payer enrollments.
• Liaise with insurance companies to resolve credentialing issues and expedite approvals.

Athenahealth System Optimization:

• Configure and customize Athenahealth workflows to improve efficiency and accuracy.
• Train staff on Athena billing and credentialing best practices.
• Monitor system updates and ensure compliance with new regulations and payer requirements.

Qualifications:

• Required: Minimum 1 year of experience with Athenahealth billing and credentialing.
• Strong knowledge of CPT, ICD-10, HCPCS codes, and insurance guidelines.
• Experience working with Medicare, Medicaid, and commercial payers.
• Proficiency in resolving denials, appeals, and compliance-related issues.
• Excellent analytical, problem-solving, and communication skills.
• Preferred: Certification in Medical Billing & Coding (CPC, CPB) or equivalent.

For interested applicants of referrals, please fill out this form https://forms.monday.com/forms/41e09516ba964ea359fe88460732f976?r=use1

Or send your resume/CV to recruiting@golean.health