Department: Finance & Billing
Hours: Monday - Friday, 8:30am - 5:00pm
Location: Onsite, 1205 Broadway, Lorain, OH 44052
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PRIMARY PURPOSE*
The Credentialing Associate is responsible for all aspects of the credentialing and re- credentialing processes, in coordination and under the direction of the Billing Supervisor and the Director of Human Resources, for all licensed independent providers who deliver patient care at LCH&D. Additionally, the Credentialing Associate functions as an associate biller, working closely with insurance carriers, providers, and fellow staff to meet the billing and payment needs of our patients and the organization as a whole.
EDUCATION AND CERTIFICATION REQUIREMENTS
- Must have a high school diploma or GED.
SKILL AND EXPERIENCE REQUIREMENTS
- At least 2 years of experience of clerical experience working in the medical or dental field.
- Previous billing or provider credentialing experience preferred.
- Strong computer skills with proficiencies in Outlook, Word, and Excel.
- Ability to maintain a calm and professional demeanor and communicate enthusiastically with potential Providers.
- Knowledge of dental and medical terminology.
- Ability to independently coordinate multiple tasks.
- Ability to be responsive in working with a culturally-diverse patient population.
- Ability to work cooperatively with others.
PHYSICAL DEMANDS
- Extensive use of computer and telephone.
- Some lifting of supplies and equipment up to 50 lbs.
- 10% walking or standing, 90% sitting at a desk.
- Category II re: exposure to blood, bodily fluids, and communicable diseases.
ESSENTIAL FUNCTIONS
- Gather all pertinent information required to complete the billing process which includes but is not limited to the following actions:
- Enter charges, payments, and adjustments into the practice management system.
- Print and mail paper insurance claims.
- Review denied claims and resubmit as appropriate.
- Facilitate all credentialing with health plans and managed care plans.
- Maintain up-to-date data for each provider in the credentialing database (CAQH) and online systems.
- Ensure timely renewal of licenses and certifications of LIP’s and OCCP’s.
- Maintain and regularly publish the Provider insurance roster.
- Monitor exclusions lists monthly for all employees.
- Works in conjunction with the billing team and insurance representatives to facilitate any problems that arise relating to credentialing.
- Must maintain accurate records.
- Comply with HIPAA guidelines at all times.
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BENEFITS*
- Excellent Training and Orientation Program
- Paid Holidays
- Generous Paid Time Off (PTO)
- Health, Dental, and Vision Insurance
- Prescription Coverage
- Employer Paid Life Insurance
- Employer Paid Short- and Long-Term Disability
- 401(k) Retirement Plan
- Giving back, outreach, and true advocacy to the patient community we serve.
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Equal Opportunity Employer_
Job Type: Full-time