RCM Specialist

Clinical Associates, P.A.•Towson, MD

3d•Onsite

About The Position

At Clinical Associates, we make being healthy easier. As a premier multi-specialty physicians' practice located in the Towson, Pikesville, and Reisterstown communities, we connect our patients to a seamless system of integrated medical care. Our practice includes in-house specialists in areas of medicine, from cardiology to podiatry. We also offer unique services like our nuclear stress testing facility. We are seeking to hire an experienced RCM Specialist to join our billing team in Towson! Our ideal candidate will possess at least 2 years’ experience in medical billing, be a team player, and provide excellent internal and external customer service. Knowledge of the credentialing process for health care providers is mandatory being that this position provides back up support to the credentialing coordinator. Job Duties include but are not limited to the following: Obtain eligibility and authorizations for services. Contact payers for claim status and general inquiries. Follow up on claim denials. Create encounters and enter charges for various services including cardiac interrogations, home health and hospital visits. Answers emails and billing related tasks in a timely manner according to company protocol. Writes appeals/ Scans Documents The RCM Specialist will assist as a backup to the Credentialing Coordinator. The following processes will be performed in conjunction with those duties listed above: CREDENTIALING/PAYOR EMROLLMENT: Perform all duties related to credentialing/re-credentialing and enrollment of payors for initial and current providers. Provide credentialing application to all newly hired providers, assist with completion of all applications, and needed documents with timely return for processing. Perform all duties related to provider departure including notification to payors and hospitals. Verify all credentials and malpractice claims through the state licensing board and other PSV sources. On an ongoing basis, remind providers when licenses require renewal. Assure applications are processed within a thirty-day processing time frame. Prepare file for presentation to the MAC of Clinical Associates for disposition. Coordinate all credentialing-related appointments with the hospital. Facilitate the reappointment process for hospital privileges. Maintain/update physical credentialing files for each provider. Maintain all credentialing databases such as CAQH, NPDB, NPPES, PECOS, ePREP and other identified databases. Act as liaison between administrative staff of Clinical Associates and the payors in resolving credentialing issues for physicians. Request malpractice insurance for newly hired providers as appropriate. Request claims history from malpractice company as needed. Perform all administrative duties as related to renewal of malpractice insurance for the company. Process tail coverage for all departing providers following policies of the malpractice insurance company and Clinical Associates. Provide copies of malpractice face sheets to appropriate entities as needed. Initiate and renegotiate MCOs and small to medium commercial payor contracts for Clinical Associates. . MINIMUM QUALIFICATIONS: Bachelor’s Degree. Will consider non-degreed candidates with significant relevant experience of at least 2 years with hands on credentialing of providers. CPCS certification preferred. Extensive familiarity with insurance carriers’ credentialing requirements. Computer literate (Excel, Nitro, Access) with a willingness and ability to learn new applications. Knowledge of Credentialing databases and other software programs to include CAQH, NPDB, ePREP, NPPES and PECOS. Knowledge of EHR esp. Nextgen. Experience with checking provider status in various databases, such as NPPES, CDS, DEA, OIG, Medicare, NPDB, etc. Excellent oral communication skills with ability to hear and to speak standard English clearly and concisely. Excellent written communication skills with ability to read, write and spell standard English clearly and concisely. Ability to interact effectively with culturally diverse patient, practitioner, and employee population. Ability to convey a positive attitude and project a professional image. Ability to remain flexible and maintain confidentiality. Possesses excellent time management skills. Requires long periods of sitting, intermittent standing, reaching, and bending. Ability to maintain reliable attendance. Benefits: · PTO · Medical, vision and dental benefits · Life Insurance · Long Term Disability · Paid Holidays · 401K Clinical Associates is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.

Requirements

Bachelor’s Degree. Will consider non-degreed candidates with significant relevant experience of at least 2 years with hands on credentialing of providers.
Extensive familiarity with insurance carriers’ credentialing requirements.
Computer literate (Excel, Nitro, Access) with a willingness and ability to learn new applications.
Knowledge of Credentialing databases and other software programs to include CAQH, NPDB, ePREP, NPPES and PECOS.
Knowledge of EHR esp. Nextgen.
Experience with checking provider status in various databases, such as NPPES, CDS, DEA, OIG, Medicare, NPDB, etc.
Excellent oral communication skills with ability to hear and to speak standard English clearly and concisely.
Excellent written communication skills with ability to read, write and spell standard English clearly and concisely.
Ability to interact effectively with culturally diverse patient, practitioner, and employee population.
Ability to convey a positive attitude and project a professional image.
Ability to remain flexible and maintain confidentiality.
Possesses excellent time management skills.
Requires long periods of sitting, intermittent standing, reaching, and bending.
Ability to maintain reliable attendance.

Nice To Haves

CPCS certification preferred.

Responsibilities

Obtain eligibility and authorizations for services.
Contact payers for claim status and general inquiries.
Follow up on claim denials.
Create encounters and enter charges for various services including cardiac interrogations, home health and hospital visits.
Answers emails and billing related tasks in a timely manner according to company protocol.
Writes appeals/ Scans Documents
Perform all duties related to credentialing/re-credentialing and enrollment of payors for initial and current providers.
Provide credentialing application to all newly hired providers, assist with completion of all applications, and needed documents with timely return for processing.
Perform all duties related to provider departure including notification to payors and hospitals.
Verify all credentials and malpractice claims through the state licensing board and other PSV sources.
On an ongoing basis, remind providers when licenses require renewal.
Assure applications are processed within a thirty-day processing time frame.
Prepare file for presentation to the MAC of Clinical Associates for disposition.
Coordinate all credentialing-related appointments with the hospital.
Facilitate the reappointment process for hospital privileges.
Maintain/update physical credentialing files for each provider.
Maintain all credentialing databases such as CAQH, NPDB, NPPES, PECOS, ePREP and other identified databases.
Act as liaison between administrative staff of Clinical Associates and the payors in resolving credentialing issues for physicians.
Request malpractice insurance for newly hired providers as appropriate.
Request claims history from malpractice company as needed.
Perform all administrative duties as related to renewal of malpractice insurance for the company.
Process tail coverage for all departing providers following policies of the malpractice insurance company and Clinical Associates.
Provide copies of malpractice face sheets to appropriate entities as needed.
Initiate and renegotiate MCOs and small to medium commercial payor contracts for Clinical Associates.