About this opportunity
Union Community Care lists this Billing/Payer Enrollment Specialist (63202) opportunity in lancaster, Pennsylvania. Review the employer’s description below for duties, qualifications and application requirements.
Job description
Billing/Payer Enrollment Specialist (63202)Administration - Lancaster, PA 17602Job DescriptionOur Mission, Vision, & Model of CareAt Union Community Care, our purpose is at the forefront of all that we do: we stand for whole health to help you live your fullest life.We envision vibrant and healthy communities supported by inclusive healthcare that embraces each member's unique culture, needs, and values, and emboldens them to make healthful choices that fuel their well-being and the well-being of others.We believe in whole health. This means we address and heal disease but equally important, we work at the causes of the causes, the social ills that must be addressed to achieve true equity.We listen, learn, and embrace the complex lives and unique strengths of our patients, and we work hard to break down all barriers to care. This means we look through a grassroots lens. We connect with our communities because we are our communities. Each of us is a neighbor, a friend, a family member, and together, we are a trusted community health center.QualificationsJob Duties:Completing all initial payer enrollment applications for commercial and government payers and completing timely follow up.Completing and maintaining all CAQH profiles for all providersEnsuring that re-credentialing and revalidations are completed timely to prevent any lapse in enrollmentMaintenance of credentialing and billing information in the Credentialing enrollment systemCommunicating with payers, providers, and other entities to quickly and accurately obtain or provide information beneficial to the credentialing or enrollment needs of the organizationMaintaining knowledge of current health plan and agency requirements for credentialingEnsuring practice addresses are current with government and commercial health plans, agencies and other entitiesMaintaining confidentiality of provider informationTerminating enrollment with government and commercial payers upon resignation or termination of providersUpdating and maintaining National Provider Identification files for locationsUsing the electronic billing system, along with any of the organization's proprietary spreadsheets or software, purchased or leased, as the primary source of immediate notification and maintenance of enrollment related dataResponding to the enrollment services dashboard tasks and overall maintenance and contentCommunicating with Athena Health Enrollment Services as needed both verbally or through tasks and casesMonitoring worklists to identify increases in accounts receivable or claims denials related to enrollment and credentialing issues, and working toward resolutionCollaborate with Billing Specialist on any issues related to payer enrollment.Processes and posts insurance payments along with patient payments in an accurate and timely manner in accordance with Union Community Care's policies, procedures and performance goals.Coordinates with PAS to ensure accurate patient information for billing purposesPerforms a variety of general clerical duties, including telephone reception, mail distribution, and other routine functions.Works Claim Holds and Denials by investigating (calling), correcting and resubmitting claims to third party payersAnswers questions from team members, patients and insurance companiesMaintains patient demographic information, including insurance eligibility and benefit verificationParticipates in educational activities and attends staff meetingsMaintains strict confidentiality and adheres to all HIPAA guidelines and regulationsPerforms other work-related duties as assignedSPECIFIC JOB DUTIES- Billing Team LeadPerforms all duties of Billing/Payer Enrollment SpecialistWorks with Billing Specialists to research appropriate billing & coding proceduresWorks with Director of Billing to maximize revenue potential based on our unique services and providersWorks with Director of Billing to maximize department efficiencyAssists with reconciliation errorsWorks with Accounting to identify any discrepancies in cashKeeps ongoing knowledge of current CPT/CDT guidelines and educates Billing SpecialistsResponsible for Training of Billing StaffAssists with Training of PASCertification in Medical Billing or Coding preferredQualifications, Skills and Knowledge Required:3 years minimum experience in a payer enrollment related fieldKnowledge and thorough understanding of managed care operations including enrollment, credentialing, contracting and claimsKnowledge of payer processes, local, state, and federal requirementsExcellent written and oral communication skillsStrong organizational, problem solving and decision-making skillsAbility to prioritize and manage multiple projects and issues effectively and simultaneouslySelf-motivated and self-starter who can work well under minimal supervisionStrong attention to detail, research and follow up skillsKnowledge of medical terminology and current CPT OR CDT coding practices preferredWorking knowledge of Microsoft Office, EMR software's and other online programs; along with general business equipmentBasic mathematic skillsSpanish proficiency preferredAbility to work well with othersESSENTIAL FUNCTIONSTo fulfill the requirements of this position, all duties are considered essential functions of the job.ORGANIZATIONAL INVOLVEMENTThis position is required to participate in mandatory all staff meetings, team meetings and trainings.
Worksite address
lancaster, PA, 17602, US
Who can apply
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