Peninsula Community Health Services of Alaska · 3 days ago
Provider Enrollment/Billing Specialist - NOT REMOTE
Soldotna, AK
Full-time
Onsite
Mid Level
3+ years expPeninsula Community Health Services of Alaska is seeking a Provider Enrollment/Billing Specialist to ensure the financial well-being of the organization through timely and accurate enrollment of providers and insurance claims processing. The role involves coordinating provider enrollment, managing billing processes, and collaborating with various stakeholders to resolve issues related to claims and payments.
Government Administration
Responsibilities
Complete provider and group enrollment for all PCHS sites
Successfully implement the entire enrollment process for all providers, adhering to all timelines while maintaining strict confidentiality for matters pertaining to provider credentials
Coordinate credentialing data needed for enrollment
Effectively communicate with providers to ensure timely completion of outgoing and incoming applications
Maintain provider credentialing files electronically via provider enrollment software and CAQH
Complete revalidation of previous enrolled providers and groups
Communicate with insurance payers to resolve provider enrollment issues
Assist with credentialing tasks as needed or assigned
Develop a payor contact list and keep current
Develop and maintain a tracking list for provider enrollment
Help the billing department with any payment issues relating to PPO’s we contract with
Maintain Medicaid and Medicare Org numbers: Do updates, etc
Maintain PPO sites for accuracy, changes, etc. This includes Availity, OneHealth Port, Medicare, etc
Provider Billing enrollment in all PPO’s plus Medicare/Medicaid/CAQH
Terminate providers from all Payor sources when they terminate
Utilize Enrollment email address to keep others in the loop
Work with Provider to do all credentialing of payor sources when they come due
Collaborate with staff, providers, team members, patients, and insurance companies to get all claims processed and paid
Capable of performing all aspects of medical billing independently, including but not limited to, charge entry, posting insurance payments, rejections and follow-up
Assign correct diagnosis (ICD-10) and procedure (CPT) codes based on direction from providers
Must have specific knowledge of diagnostic and procedural terminology
Monitor aging to ensure timely follow-up of claims resolution, reduction of future denials, ensuring accurate payment, and escalation of issues to management as identified
Conduct insurance re-verification as needed through various tools and initiate billings to a new payer, reprocess the claim accordingly, or bill the patient
Research payer guidelines and write and submit appeals as appropriate
Manage collections
Complete VA prior authorizations
Review and appeal unpaid and/or denied claims
Prepare, verify, submit and track prior authorizations, including VA
Provide Good Faith Estimates to uninsured patients per federal regulation
Verify patient coverage and insurance benefits
Answer patient billing questions
Process insurance and patient refunds
Handle self-pay collection efforts on all unpaid accounts and submit to Collections on a timely basis
Continuous data entry into state/federal/local reporting programs such as AKAIMS
Administrative responsibilities associated with meeting reporting requirements
Audit data when necessary and/or appropriate
Generate, process, and/or mail monthly statements
Knowledge of how to post in all electronic health record systems
Post payments, adjustments, and denials in systems as appropriate
Balance daily deposits to daily postings for all systems
Keep billing spreadsheets up to date, checking daily
Check allowables to ensure correct payment and account balances
Post zero pay correspondence as pertaining to: deductibles, copayments, and denials
Process credit card payments and balance credit card machine transactions daily
Run weekly conveyance reports to verify everything is in balance for month end
Ensure that desktop procedures are current
Perform month-end closing procedures
Perform duties as assigned by the CFO
Qualification
Required
High School Graduate
3-5 years of healthcare claims processing and/or billing/coding experience required
Must be computer literate, proficient with Microsoft Office Products and be able to type 45 wpm and must have 10 key skills
Possess 'people skills' and enjoy working in a health care setting
Possess the tact required for securing payment or discussing patient's finances
Pass a State required background check plus a pre-hire drug screen
Preferred
Certified Medical Coder (AAPC or AHIMA) preferred but not required
FQHC experience preferred
Company
Peninsula Community Health Services of Alaska
Peninsula Community Health Services of Alaska, Inc.
51-200 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase