Credentialing and Billing Coordinator

This is a fully remote position, open to applicants in Connecticut.

📋 Description

• Oversee the insurance credentialing process for PTSMC providers and their locations.

• Credential individual clinicians and provide prompt updates.

• Manage EMR signature protocols to ensure precise and clean claims submissions.

• Supply insurance carriers with the necessary information for re-credentialing existing clinicians and locations.

• Maintain CAQH records for active PTSMC clinicians.

• Complete applications and familiarize yourself with the credentialing process for joining new networks.

• Initiate temporary permit procedures and follow up on their status as necessary.

• Track license transfers and conduct follow-ups as required.

• Perform quarterly provider and demographic verifications for participating insurance plans.

• Address any missing or incorrect provider demographic details with payers.

• Filter and submit claims from the In-Review work queue on a daily basis.

• Correct failed edits, claim rejections, and changes in insurance.

• Resubmit modified or corrected charges once claim addenda are finalized.

• Manage self-pay visits by reviewing patient charges and generating remits to conclude visits.

• Stay updated on insurance participation, contract reimbursement, payer guidelines, and policies.

• Revise insurance information and rebill claims to resolve billing discrepancies.

• Monitor billing on hold for newly non-credentialed providers.

• Review and rectify claims denials concerning provider participation.

• Keep abreast of changes in insurance policies through website updates and insurance newsletters.

• Assist in coordinating and communicating insurance information for accurate billing.

⛳️ Requirements

• Attention to detail.

• Strong problem-solving skills.

• Ability to collaborate effectively.

• Familiarity with ICD-10 diagnosis codes.

• Understanding of CPT billing codes.

• Knowledge of billing modifiers.

• Awareness of non-reimbursable codes.

• Understanding of insurance participation, contract reimbursement, payer guidelines, and policies.

🏝️ Benefits

• 401(k).

• Dental insurance.

• Disability insurance.

• Health insurance.

• Life insurance.

• Paid time off.