The Bridge · 1 day ago
Billing & Credentialing Specialist
New York, NY
Full-time
Onsite
Mid Level
3+ years expThe Bridge is a recognized leader in providing supportive housing and behavioral health services to vulnerable New Yorkers. As a Billing and Credentialing Specialist, you will manage the credentialing process for providers and handle billing for key programs, ensuring compliance with regulatory standards.
Health CareMental HealthOutpatient CareRehabilitationResidential
Responsibilities
Process agency wide provider and agency enrollment, credentialing, and revalidation through eMedNY, PECOS, Availity, CAQH
Verify healthcare professionals’ licenses, credentials and qualifications are valid, up-to-date, and meet regulatory and organizational standards
Keep comprehensive records of credentialing activities, including applications, verifications, and accreditation
Provide advice on renewal dates for licenses and credentials
Work closely with providers to provide guidance on credentialing compliance
Respond to inquiries and facilitate communication to resolve credentialing issues
Stay abreast of medical policy, local licensing, and certification requirements
Work with healthcare professionals and various stakeholders to ensure compliance
Prepare and maintain reports of credentialing activities
Assist auditors with credentialing activities
Manage payer credentialing, renewals, provider roster updates, and practice information requests
Effectively manage clearinghouse claims issues
Analyze and report on accounts receivable
Research/Investigate/Resolve and communicate complex claims issues
Perform other tasks assigned by the supervisor
Qualification
Required
High school diploma or Equivalent
3-5 years of experience in healthcare billing and credentialing
Strong understanding of Managed Care Payer rules and Medicare LCD and NCCI Edits
Knowledge of OMH and OASAS regulations and procedures
Knowledge of Medicare and CMS Behavioral Health guidance
Versed in third-party payer, Medicaid, and Medicare billing and payment procedures
Provider credentialing and Medicaid Excess Income process and procedure
Not-for-profit and Behavioral Health regulations
General competence with computer systems
Interpersonal skills required for effective communication/troubleshooting with program personnel and insurance plan contacts
Ability to establish and maintain effective working relationships
Ability to research and analyze data
Ability to work independently
Preferred
Associate's degree in healthcare services, health information management, or related field from college preferred or Certificate from a technical school for billing
Certified Biller or Certified Provider Credentialing Specialist
Certificate/Diploma or proven knowledge in Medical Reimbursement and Coding
Knowledge of NYS ePaces, eMedNY, CMS PECOS and NGS; Availity and AWARDS is a plus
Company
The Bridge
The Bridge provides mental health and housing solutions.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Susan Wiviott
CEO
Ezra Miller
CFO
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