Billing and Credentialing Specialist with emphasis on Behavioral Health

POSITION SUMMARY

The Billing and Credentialing Specialist is responsible for managing client information in the billing software database, submitting claims to insurance providers, and providing support to employees by leading, coordinating, monitoring, and maintaining the credentialing and re-credentialing process.

Essential Skills and Experience:

• Associates degree in related field OR three years of related experience in lieu of education.
• Medical Billing and Coding Certification or two years of experience in nonprofit billing and coding and credentialing. Must have experience in credentialing and billing for behavioral health services.
• Excellent written, verbal, and interpersonal communication skills with strong attention to detail and organization.
• Experience with Microsoft Office (Word, Excel, PowerPoint).
• Ability to work effectively in a rapidly changing, multi-task, crisis-oriented environment.
• Ability to work independently and as part of the team to ensure that the highest quality and most relevant aspects of the job and services are provided.
• Conduct relationships in such a way as to promote mutual respect, public respect, and improvement of services.
• Willing to work to support the overall mission of the organization.
• Ability to adhere to strict standards of confidentiality.
• Must possess a valid New Mexico driver's license, a clean driving record, and proof of insurance; able and willing to travel locally as needed.
• This position is subject to Criminal Background Check (post-offer).

DUTIES & RESPONSIBILITIES

Credentialing:

• Meet with newly hired employees to obtain necessary information for credentialing process within 30 days of start date.
• Responsible for credentialing all billable staff.
• Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications.
• Assist employees to apply for and renew all provider licenses as needed.
• Complete revalidation requests issued by government payers.
• Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid.
• Complete re-credentialing applications for commercial payers.
• Work closely with the finance team to identify and resolve any denials or authorization issues related to provider credentialing.
• Maintain accurate provider profiles on all applicable databases.
• Work with Finance to create SOPs for credentialing new staff.

Billing:

Prepare, review, and transmit claims using billing software, including electronic and paper claim processing in a timely manner.

• Be able to bill MCOs for all staff who have been employed at CRFW within 30 days of employment.

Ensure all staff have an NPI and Medicaid Number. Fully understand and be able to explain the way medical insurance works. Regularly communicate with staff in order to obtain client insurance information. Follow-up on any unpaid medical claims within the standard billing cycle. Call insurance companies about any discrepancy or issues in payments as needed. Check each insurance payment for both accuracy as well as compliance. Research and appeal denied medical claims. Answer all insurance inquiries. Update billing software with any rate changes. Use specialized software for submitting insurance claims. Review client information and records and reliably code them. Maintain patient confidentiality. Be aware of various changes in the insurance industry.

Other:

1. Attend scheduled All-Staff meetings. 2. Other duties as assigned and relevant to the success of the mission of Crossroads for Women.

PHYSICAL DEMANDS

Consistent and regular use of phone required. Regular and consistent use of keyboard and mouse. Ability to climb stairs on occasion. Must be able to occasionally lift up to 25 pounds. Consistent sitting for many hours at one time. The majority of the day (50%+) is spent sitting at a desk. Additional challenges may arise, at which time CRFW may revise this job description.

Job Type:

Full-time Pay:

$40,000.00 - $55,000.00 per year

Benefits:

401(k) Dental insurance Health insurance Life insurance Paid time off Vision insurance People with a criminal record are encouraged to apply

Education:

High school or equivalent (Preferred)

Experience:

Behavioral Health Credentialing:

2 years (Required) Medicaid billing in a behavioral health setting: 2 years (Required)

Language:

Spanish (Preferred)

Work Location:

Hybrid remote in Albuquerque, NM 87102