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BILLING AND CREDENTIALING SPECIALIST

Full-Time (40 hours per week) one evening per week may be required 
Located at the Johnston office, 1126 Hartford Avenue
Posted:  November 30, 2016

The Billing and Credentialing Specialist is responsible to ensure that all medical, dental, and behavioral health billing is performed in a timely and accurate manner to ensure optimal reimbursement.  This position will process claims, research and resubmit denied claims, resolve billing complaints, post payments and denials, answer questions from various sources including patients, administrative and fiscal staff, and insurance companies, manage work lists and/or tasks, escalate to appropriate parties and follow up on open issues to ensure timely resolution.  The Billing and Credentialing Specialist will work in coordination with Human Resources and Health Center Leadership to ensure timely processing and completion of all provider credentialing applications, re certification, updates and terminations as appropriate. 

RESPONSIBILITIES:  Reviews claim holds and facilitates clean claim processing; ensures all claims have been submitted in a timely manner; manages work-lists and tasks, escalates issues to appropriate parties and follows up on open issues in a timely manner; ensures statements are generated and processed in a timely manner; answers questions from patients, administrative/fiscal staff and insurance companies; resolves patient billing complaints; evaluates patient's financial status and follows policy to establish payment plans, handles bad-debt write-offs and hardship adjustments; documents all billing activities in the patient medical record system; collects patient's statement payments, prepares deposits and posts to the practice management system; reconciles all payments, adjustments and write-offs; prepares monthly fiscal reports or as requested; prepares and processes provider credentialing applications to completion and follows to ensure the credentialing process is complete with the insurance payer; updates demographics, etc. for providers through various credentialing sources and ensures re-certification as needed; notifies insurance plans at provider termination; assists in the training of staff in billing related topics and responsibilities; performs other duties as assigned.

REQUIREMENTS:  High School Diploma or GED is required; graduate from an accredited Medical Billing Program, or equivalent; knowledge of ICD-10 coding; medical terminology and health insurance/authorization knowledge; previous experience in billing for a federally qualified community health center is preferred.

SPECIAL REQUIREMENTS: Ability to read/interpret medical records; effective verbal and written communication skills; organized and able to manage competing priorities; cultural sensitivity necessary to work with a diverse patient and staff population; bilingual preferred, English and Spanish speaking. 

APPLICATION PROCESS: Cover letter and resume due to Tri-County Community Action Agency's Human Resources Director, Sue Connaughton at sconnaughton@tricountyri.org; fax to 401-351-6611 or mail to Tri-County Community Action Agency, 1126 Hartford Avenue, Suite 201, Johnston, RI 02919.

For more information on applying to Tri-County Community Action, click here. 

Tri-County Community Action Agency is an Equal Opportunity Employer




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South County Community Action Agency  ·  1935 Kingstown Road, Wakefield, RI 02879  ·  P: 401-789-3016  ·  F: 401-515-0139
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