Clinic Billing and Credentialing Representative 1.0 FTE

Waverly Health Center - Waverly, IA

Part-time

Waverly, IA

Hospitals

About the position

The Clinic Billing and Credentialing Representative at Waverly Health Center is responsible for managing insurance billing and credentialing processes for both the clinics and the hospital. This role involves coordinating credentialing activities, handling patient accounts, and ensuring compliance with insurance regulations. The representative will work closely with various departments to address billing inquiries and maintain accurate records.

Responsibilities

• Responsible for all insurance credentialing and re-credentialing for Waverly Health Center hospital and clinics.
• Sends out regular status updates on provider credentialing to administration.
• Assists with hospital credentialing and privileging by coordinating and completing assigned documentation.
• Assists in handling and responding to provider needs using current policies.
• Keys payments and adjustments to patient accounts.
• Scans all incoming checks from insurance and posts to appropriate accounts, applying discounts when necessary.
• Pulls in electronic remittance advices from the clearinghouse on a daily basis for electronic posting.
• Balances posting and makes a daily deposit.
• Responds to patients' questions regarding their accounts.
• Answers all insurance questions from front office clerical staff.
• Works closely with other departments in addressing issues related to any service provided.
• Reviews Explanations of Benefits that accompany payments.
• Files balances due to secondary payers or works denied claims from insurance Explanation of Benefits.
• Files corrected claims based on payer rules.
• Analyzes accounts that have payer specific edits, timely filing limits or needs filed manually.
• Utilizes online insurance systems to check claim status or denials.
• Responsible for refunds to patient and insurance companies.
• Sends statements on a daily basis and updates patients' address information from returned statements.
• Follows through the collection process on past due accounts.
• Sets up Payment Agreements for Private Pay Accounts.
• Posts payroll deductions for employees.
• Works with patients to set them up for Care Payment.
• Enters all new insurances into electronic medical record.

Requirements

• Must possess high school diploma or equivalent.
• Two years of medical insurance experience in a physician's office or clinic setting is preferred.
• Strong understanding of Medicare, Medicaid, and commercial insurance rules and regulations as they apply to a physician's office and/or clinic setting.
• Ability to learn and navigate computer systems including online training modules and job-specific systems.
• Must have good interpersonal and organizational skills.
• Must be able to read, speak, and write fluent English.