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Provider Credentialing & Billing Specialist

Company: Seattle Indian Health Board
Location: Seattle
Posted on: February 15, 2018

Job Description:

Job DescriptionPosition Purpose: Provider Credentialing/Billing Specialist will process and maintain all clinic provider insurance credentialing paperwork and website enrollments. In addition will assist with various insurance billing tasks. This position will develop close working relationships with HR and Providers. Implement and maintain credentialing policies and procedures to ensure compliant credentialing of providers.Position Complexities: Provider Credentialing Specialist must have deep understanding of insurance credentialing guidelines.Knowledge of websites for credentialing processing, CAQH, PECOS, etc.Knowledge of standard medical billing practices.Processing of renewals and CMS attestations.Position's Impact to SIHB:This position has a large impact on SIHB. Provider credentialing impacts the revenue cycle and the providers ability to treat patients and be reimbursed for those services.The main responsibility of this position is safe guarding SIHB provider credentials with various insurance’s.Duties & Responsibilities:

  • The Credentialing Specialist is responsible for the creation of provider credential applications with insurance companies.
  • Work with providers and HR to obtain needed provider data for enrollment.
  • Website enrollments, i.e. CAQH, PECOS etc.
  • Renewal of credentials and attestations with CMS
  • Maintenance of provider numbers in Practice Management system.
  • Practice Management system workqueue review of denied claims due to credentialing issue.
  • Drafting of appeal letters to insurances due to denials for not credentialed.
  • Comply with policies and procedures such that provider data is handled in a strictly confidential manner.
  • Other duties as assigned.Required Qualifications:
    • High School Diploma or GED
    • Minimum 1-year provider credentialing and medical billing experience required. Preferred Qualifications:
      • CPCS, (Certified Provider Credentialing Specialist) Certification
      • Working in an FQHC environment Company DescriptionThe Seattle Indian Health Board (SIHB) is a private, non-profit 501(c)3 organization incorporated in the State of Washington. We provide community health care and services targeting the urban American Indian and Alaska Native population in the greater Seattle/King County area. We are state-recognized and our ambulatory health care services are nationally accredited through the Accreditation Association for Ambulatory Health Care. We have been serving our community since 1970.

        Keywords: Seattle Indian Health Board, Seattle, Provider Credentialing & Billing Specialist, Accounting, Auditing, Seattle, Washington

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