Job Description

A large, multi-specialty surgical group in Westchester is seeking an Accounts Receivable/Credentialing Representative on a temp-to-hire, or direct hire basis. This position will be fully onsite, Monday through Friday, 9am - 5pm. Our client is seeking candidates who have experience with Provider Credentialing and will provide training on their Accounts Receivable functions.

RESPONSIBILITIES:

• Serving as a liaison between practice, credentialing company, and new/current providers; obtaining all necessary information to complete insurance credentialing, current hospital credentialing/privileges and re-credentialing status, ensure applicable fees and permits are issued and kept current, submit current malpractice liability certificates
• Organize, file, maintain detailed records of all credentialing and receivables information in designated drives, EMR, and/or other systems
• Analyze EOB information, co-pays, deductibles, co-insurance, contractual adjustments, underpayments and denial reasons.
• Review, follow up and respond to inquiries via email, phone or incoming correspondence in a timely manner to resolve outstanding balances, patient complaints or questions regarding the billing process
• Review patient account balances to ensure all patient payment are applied appropriately.

REQUIREMENTS:

• Experience obtaining the initial status of medical claims by calling insurance carriers and/or checking online web portals
• Experience with follow up via carrier communication through phone/online web portals to resolve issues and ensure claims are paid timely and appropriately
• Experience resolving denials and submitting appeals: Identify and resolve denials and payment variances and act to resolve issues through claims reprocessing, claim corrections, and/or drafting and submitting reconsiderations/appeals
• Proficiency in Microsoft Office Suite including Outlook, Word, Excel and OneDrive
• Knowledge of CPT/ICD10, medical terminology
• Familiarity with EMR systems preferably Centricity, ModMed or equivalent
• High level of customer service & interpersonal skills to work effectively with insurance companies, patients, physicians, and other team members in the practice
• high level of accuracy and attention to detail, well-organized, self-motivated, and ability to multi-task while working in a fast-paced environment to meet various deadlines
• Abide by HIPAA and any state and federal laws to remain complaint in accordance with practice policies and procedures
• Ability to read and interpret explanations of benefits, insurance denials, partials payments, adjustments, and recoupments

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