Revenue/Credentialing Specialist Position Available In Holmes, Mississippi

Revenue/Credentialing Specialist Dr Arenia C Mallory Community Health Center Inc 300 Yazoo St, Lexington, MS 39095 Revenue/Credentialing Specialist Mallory Community Health Center Are you detail-oriented, organized, and passionate about ensuring smooth operations in a healthcare setting? Mallory Community Health Center is seeking a Revenue/Credentialing Specialist to join our team. In this role, you’ll be essential in ensuring the financial health of the organization while also ensuring our healthcare providers are properly credentialed to deliver high-quality care. If you thrive in a fast-paced environment and have a passion for healthcare administration, we’d love to hear from you!

About Us :

At Mallory Community Health Center, we are committed to providing high-quality, patient-centered care to our community. We believe in a collaborative work environment where each team member plays an integral role in promoting the health and well-being of our patients. Why Join Us?

Mission-Driven Work:

Support a community-focused healthcare organization dedicated to improving lives.

Professional Growth:

Opportunities for training, development, and career advancement.

Comprehensive Benefits:

Competitive salary, health insurance, retirement plans, and more.

Positive Work Environment:

Join a team of passionate professionals in a supportive setting.

Key Responsibilities:

Revenue Duties and Responsibilities Gather Medicaid, Medicare, and insurance billing information by reviewing patient medical records and checking for completeness. Ensure payments by verifying accuracy of Medicaid, Medicare, and insurance coding. Bill Medicaid, Medicare, and Insurance carrier by inputting billing information to database and initiating electronic transmissions. Resolve disputed claims by gathering, verifying, and providing additional information, following-up on claims. Resolve discrepancies by examining and evaluating data and selecting corrective steps. Assist patients with billing inquires, payments, and account discrepancies. Adjust patient bills by reviewing remittance advice and consulting with receptionist. Prepare monthly reports of Medicaid, Medicare, and Insurance billing by summarizing billings, adjustments, and revenues received. Perform a variety of billing functions, including charge and payment posting, processing of electronic EDI claims and electronic Explanation of Benefits (EOBs), tracking and follow-up on outstanding or denied claims, and receivable management tracking and reporting Review and audit critical billing and clinical information in multiple specialties. Ensuring that diagnoses codes (ICD-9-CM coding and

ICD-10-CM

) support the services provided, E&M code levels support the complexity of the visit, and appropriately coded CPT procedures are properly documented in the EHR for each visit. Resubmit all the necessary claims and documentation in a timely manner. Contact insurance companies for status on claims as necessary. Report to Supervisor concerning problems with insurance and patient account balances. Work closely with the Billing Manager and billing staff to identify and resolve any denials or authorization issues. Process all incoming and outgoing billing mail, following up as needed. Post payments, adjustments, and zero-pay EOBs in an accurate and timely manner. Post patient payments in an accurate and timely manner to the appropriate line-item charge. Research and resolve “unapplied and/or unidentified” payments to ensure monies are properly distributed. Enter and balance payments as assigned by category (Check, Credit Card and/or Electronic Payments) by batch to internal deposit records for the day. Process end of day reports (internal deposit slips and clearing of financial queue). Identify collection issues with insurance or patient accounts and communicate with the Billing Team. Work closely with the Billing Manager and billing staff to identify and resolve any denials or authorization issues related to provider credentialing. Serve and protect the organization by adhering to professional standards, insurance policies and procedures, federal, state, and local requirements. Stay abreast of job knowledge by participating in educational opportunities; reading professional publications; keeping current on Medicaid, Medicare, Insurance billing and reimbursement procedures. Credentialing Duties and Responsibilities Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payor credentialing applications. Maintain internal provider grid to ensure all information is accurate and logins are available. Maintain accurate and up to date provider profiles on CAQH, PECOS, NPPES, and CMS databases. Complete credentialing, re-credentialing, and privileging applications to add providers to commercial payors, Medicare, and Medicaid. Apply for and renew annually all provider licenses; Professional, DEA, Controlled Substance. Complete revalidation requests issued by government payors. Credential new providers and re-credential current providers with hospitals at which they hold staff privileges. Perform other necessary duties as required by the Community Health Center to meet the goals of providing primary health care

Qualifications:

Education and/or

Work Experience:

AA Degree from a Business or Technical school with one-year experience or High school diploma or GED with 3 years of related and/or training or equivalent combination of education and experience. Experience in medical/dental billing (ICD-10 CPT and HCPCS).

SkillsAbilities:

Knowledge of insurance billing, coding, and reimbursement processes Strong understanding of credentialing processes and relevant regulations (e.g., NCQA, CMS, payer-specific guidelines) Familiarity with Electronic Health Records (EHR) systems and practice management software Excellent organizational skills with exceptional attention to detail Ability to handle confidential information with professionalism and discretion Strong communication and interpersonal skills, with the ability to work collaboratively with healthcare providers, payers, and other team members Ability to problem-solve and resolve issues effectively and in a timely manner

What We Offer :

Competitive salary and benefits package Health, Dental, and Vision Insurance Company Paid Basic Life/AD&D Insurance Ancillary Benefits (Accident, Cancer, Disability, Critical Illness, Whole Life, Term Life, and Hospital Confinement) Retirement plan options Generous vacation/sick leave and holiday pay schedule Public Service Loan Forgiveness (PSLF) Eligible Employer Loan Repayment and Scholarship Opportunities Supportive, friendly work environment with opportunities for professional development and growth The opportunity to make a real impact in the lives of our patients Join Our Team! If you are a motivated candidate looking to make an impact, we would love to hear from you! Apply today to become part of Mallory Community Health Center , where your skills and dedication contribute to the success of our organization and the well-being of our community. Be a Part of Something Bigger! At MCHC, we believe in our mission to drive meaningful change in the communities we serve. If you’re ready to apply your expertise in a role that truly makes a difference, don’t wait-take the next step in your career today. We can’t wait to welcome you to our team! Mallory Community Health Center is an Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law.