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Alternative Opiate Treatment Program - New York, NY

posted 2 months ago

Part-time - Entry Level
Remote - New York, NY
Ambulatory Health Care Services

About the position

The Medical Biller/Credentialing Specialist will support the Revenue Cycle Manager and Program Administrator in resolving patient billing issues and provider credentialing problems within an OASAS 822, CARF-accredited Outpatient Opioid Treatment Program. This part-time role involves a mix of billing and credentialing tasks, ensuring compliance with various insurance and regulatory requirements while providing exceptional service to patients and providers.

Responsibilities

  • Assist the Revenue Cycle Manager and Program Administrator in resolving patient billing issues and provider credentialing problems.
  • Maintain individual provider files for governmental and commercial payer credentialing applications.
  • Track and ensure all necessary portal logins for Managed Care Organizations, commercial payers, CMS Medicare, Medicaid, PECOS, NPPES, and CAQH are active.
  • Update CAQH database files for individual providers according to CMS Medicare/Medicaid and Managed Care Organizations regulations.
  • Assist new providers in completing applications for National Provider Identifier (NPI).
  • Terminate enrollment with government and commercial payers upon provider resignation or termination.
  • Provide updated demographic information to outside participants, such as commercial managed care plans and contracted billing entities.
  • Complete audit requests from insurance entities.
  • Ensure timely credentialing and recredentialing of individual providers.
  • Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases.
  • Verify coverage and eligibility for medical services.
  • Post charges and payments to correct accounts and obtain pre-authorization for certain procedures.
  • Communicate with insurance providers, service providers, and clients regarding billing issues.
  • Review patient bills and correct any inaccuracies.
  • Prepare and transmit claims using billing software.
  • Collect unpaid claims and resolve discrepancies through communication with insurance carriers.

Requirements

  • At least 2 years of recent medical billing experience, preferably in behavioral health.
  • At least 2 years of recent credentialing experience, preferably in behavioral health.
  • Knowledge of insurance guidelines including HMO/PPO, Commercial, Medicare, Medicaid, and other payer requirements and systems.
  • Excellent written, verbal, and interpersonal communication skills.
  • Ability to train and educate administration and staff on billing and credentialing issues.
  • Competent use of computer systems, software, and EHRs.
  • Familiarity with ICD-10 and CPT Coding.
  • Exceptional customer service skills for interacting with patients regarding medical claims and payments.

Nice-to-haves

  • Experience in software troubleshooting.
  • Creative problem-solving skills to research and resolve discrepancies, denials, appeals, and collections.
  • Ability to multitask and think creatively.

Benefits

  • Flexible work schedule with hybrid remote options.
  • Supportive work environment in a family-owned organization.
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