Medical Billing and Credentialing Specialist

Exciting opportunity to join a fast paced administrative team for a growing, high-volume Emergency Medicine Physician Practice.

University Emergency Medicine Foundation (UEMF) is an Academic Emergency Medical Practice affiliated with the Brown University School of Medicine. UEMF provides staffing of Board Certified Emergency Physicians to the region's only Level I Trauma Center as well as the State's only Children's Specialty Emergency Department; and to a leading Community Hospital.

We are currently seeking a highly motivated and professional full-time Medical Billing and Credentialing Specialist to join our dynamic practice. Under the general supervision of the Billing Operations Manager, the Billing and Credentialing Specialist will be responsible for credentialing and re-credentialing UEMF providers with health plans, hospitals, and state and federal licensure. He or she will create and maintain all credentialing files, ensure that all licensures and certifications are current and completed on time, and follow up to ensure a successful credentialing process on behalf of the providers. The Medical Billing and Credentialing Specialist will also be responsible for billing duties.  

Required Qualifications

1.       Associates Degree in Medical Office Procedures or related field required. Bachelor’s Degree in Finance, Healthcare Administration, or Management preferred.

2.       Must have 3 + years of related medical credentialing for health care providers and/ medical billing experience. Knowledge of insurance including, Medicare, BCBSRI, third-party insurance, etc.

3.       Proficient in MS Office, primarily Word, Outlook, Excel and Access.

4.       Knowledge of medical practice management systems.

5.       Must be extremely detailed oriented and able to multi-task.

6.       Must be professional and have excellent interpersonal, customer service and telephone etiquette skills.

7.       Ability to work in a fast paced work environment and work independently, while still working as a team player in the billing department.

8.       Ability to handle confidential information in a professional manner. Thorough knowledge of and compliance with state and federal laws, including HIPAA, required.

Significant Job Functions

Credentialing

1.       Obtain paperwork from providers (or Physician Services Administrator (PSA)), prepares necessary paperwork and verifies that all appropriate information needed for insurance credentialing is on file at least 90-days prior to start date and /or re-credentialing date. Tracks all documents in HRO database monthly. May assist PSA in providing Hospitals with necessary credentials and information to attain Hospital privileges or affiliations.

2.       Create and update provider data in the Council for Affordable Quality Healthcare (CAQH) database every 120 days or as needed. Coordinates with providers to review CAQH information on an annual basis.

3.       Create and update NPI application for all physicians and midlevels to include all provider numbers.

4.       Responsible for timely credentialing for all providers. Maintains an updated database of insurances with which providers are credentialed, re-credentialing dates and insurance contact persons.  Maintains a recordkeeping system to comply with UEMF, Hospital, and regulatory agencies’ requirements for employment, employee certification, and licensure.

5.       Complete IPA and PSO applications for all physicians

6.       Complete Health Connection application for all part/full time physicians for Find A Doc.

7.       Maintain and update the credentialing policies and procedures manual

8.       Notify Risk Services, Medical Staff Office, and UEMF’s Billing and Coding Departments of providers’ credentialing status. Communicates with PSA on providers’ privileging status.

9.       Travel to obtain signatures from physicians for credentialing purposes as needed.

Medical Billing

1.       Enters patient billing data information and related payments for all insurances into the practice management system

2.       Verifies insurance coverage for all third-party liability illnesses/injuries

3.       Follows up with all insurance companies regarding provider identification numbers.

 

Please apply for this position using the link below:

http://ch.tbe.taleo.net/CH08/ats/careers/requisition.jsp?org=UEMF&cws=1&rid=38

 

Payment Poster/Accounts Receivable Specialist

We are currently seeking a highly motivated and professional full-time Payment Poster/Accounts Receivable Specialist. Under the direction of the Billing Operations Manager, the Payment Poster/Accounts Receivable Specialist is responsible for posting medical payments into the practice management system. In addition, he or she will be responsible for the independent review and analysis of all areas of Accounts Receivable, auditing all Accounts Receivable related functions, and monitoring adherence to established policies.

Required Qualifications

1.       Knowledge of ICD-9 CM, CPT -4 coding and medical terminology is required.

2.       Experience with practice management systems is preferred.

3.       Must submit a background release form and demonstrate proof of being free from disqualifying information. 

4.       Excellent verbal communication/customer service skills required.

5.       Good computer/clerical skills are required.

6.       Mentor coworkers within scope of responsibility

Significant Job Functions

1.       Posting Payments

  1. Responsible for posting medical payment received and entering them into the practice management system.
  2. Responsible for posting and tracking attorney batch payments. Follows up with attorneys and patients to ensure payment.
  3. Maintains and tracks account receivable of liens on file, as needed.
  4. Responsible for collecting all information needed to process refunds in a timely fashion.
  5. Processing all denials on remits.

2. Accounts Receivable

a.       Works with insurers to effectively resolve issues for claims over 30 days old in order to maximize reimbursement.

b.      Processes electronic billing and billing edits.

c.       Responsible for posting and processing denied claims.

d.      Provides follow up on account receivable lien files.

e.      On a regular basis, audits the accuracy of randomly-selected medical claims including diagnosis codes, insurance eligibility, and timeliness of filing.

f.        Advises supervisor of findings and works with appropriate staff to resolve/correct any issues.

g.       Works with external auditors.

3. Medical Billing

  1. Enters patient billing data information into the practice management system.
  2. Researches and responds to status of patient eligibility for hospital charges.
  3. Verifies insurance coverage for all third-party liability illnesses/injuries.
  4. Notifies supervisor of any credentialing/re-credentialing issues that may arise.

 

Please apply for this position using the link below:

http://ch.tbe.taleo.net/CH08/ats/careers/requisition.jsp?org=UEMF&cws=1&rid=39

 

Emergency Medicine Physician Assistants and Nurse Practitioners

Two academically exciting, busy emergency departments in beautiful coastal Rhode Island seek experienced emergency medicine PAs and NPs for full-time positions. Join us at Rhode Island Hospital and The Miriam Hospital Emergency Departments. Both hospital sites are teaching facilities affiliated with Brown University and host a large EM residency. Rhode Island Hospital is a Level 1 Trauma Center with an adult patient volume exceeding 105,000 annual visits in our top-rated facility. We host a large main ED, Chest Pain Unit, and an Emergency Behavioral Health Unit.

Our increasing patient volume at both facilities necessitates expanding our Midlevel staffing. We are recruiting candidates with a minimum of 2 years of EM experience. Qualified candidates interested in excellent salary/benefits, along with the opportunity to advance their clinical practice and grow professionally in an academic setting.

Please apply for this position using the link below:

http://ch.tbe.taleo.net/CH08/ats/careers/requisition.jsp?org=UEMF&cws=1&rid=26

 

Medical Scribe

We are currently seeking motivated, organized, professionals for both part-time and full-time roles for our Medical Scribe positions. This position is a great opportunity for an individual interested in beginning or furthering their career in healthcare. The Medical Scribe will be responsible for assisting our Emergency Department physicians in accurately documenting and transcribing patient encounters including histories and physical exams, working directly with the physicians to maximize efficiency and optimize patient throughput, tracking laboratory and radiographic test results and transcribing them into the medical record, retrieving prior patient records including former EKGs, test results and discharge summaries, gathering medical supplies as needed for various medical procedures, completing worker’s compensation forms, MRI screening forms and next day non-invasive forms, assigning accurate evaluation and management codes, auditing physician charts and providing appropriate feedback, ensuring records are complete, and generating discharge instructions and patient prescriptions as dictated by the ED physician.

Qualified candidates will have interest in furthering a career in the medical field and will work well in a fast past environment and willingness to work 1st, 2nd, or 3rd shift.  Bachelor’s degree preferred.  Good data entry and hand writing skills. Knowledge of medical terminology, preferred.  Prior healthcare experience is an advantage.

Qualified candidates, please submit cover letter and resume using the link below:

http://ch.tbe.taleo.net/CH08/ats/careers/requisition.jsp?org=UEMF&cws=1&rid=34

  

UEMF offers competitive wages and excellent benefits, including: flexible schedule, health, dental, life, long term disability, flexible spending accounts, paid time off, and a generous retirement plan.

UEMF is an Equal Opportunity Employer - Race, color, sex, creed, national origin, religion, physical or mental disability, age, military reserve membership, sexual orientation, marital status or other characteristics protected by federal, state, or local laws are not factors in hiring, promotion, compensation, termination or any other aspect of employment. UEMF strives for a workplace free of unlawful discrimination and harassment.

Employment Contact Information

Interested candidates may send a cover letter expressing their interest in a position, and resume or CV to the attention of Alison Anderson, Human Resources Generalist.

Fax: 401-427-7796