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Coordinates Medicare and Medicaid enrollment/re-enrollment and managed care credentialing and contracting processes for providers. Serves as administrator for billing system and assists practices with system issues. Maintains NPI files and provider numbers. Serves as customer service liaison. Monitors accounts receivable to maintain appropriate levels and reviews payments to maximize reimbursement. Interacts with patients, insurance carriers, the billing vendor and practice personnel concerning patient accounts. Performs all functions in a courteous and professional manner.
Collects and maintains data on providers for Medicare and Medicaid enrollment.
Prepares and submits applications to Medicare and Medicaid for new provider enrollments and existing provider updates; follows up by telephone or in writing, with carriers regarding application status.
Complies with Medicare and Medicaid provider enrollment guidelines.
Requests NPI numbers for providers and clinics as necessary and maintains NPI files.
Follows up, either by telephone or in writing, with insurance companies and patients regarding the processing of outstanding claims and/or appeals.
Generates various reports to identify outstanding claims issues with provider numbers and non-payment.
Communicates information to appropriate personnel. Educates staff on corrections, e.g. front-end entry errors in a positive, constructive manner.
Collects and reviews managed care contracts for correct billing and payment terms.
Identifies problem accounts and follows through to completion.
Reviews Athena correspondence and unpostables.
Participates in company sponsored enrollment/credentialing meetings and other educational activities.
Participates in Billing System Training exercises and updates.
Assists in training on the Billing System software package when necessary.
Serves as a Superuser of the Billing System to be available to answer questions from the various clinics
Follows the CHRISTUS Health guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI).
Maintains strict confidentiality.
Uses oral and written communication skills to effectively convey ideas in a clear, positive manner that is consistent with the CHRISTUS Mission.
Maintains established CHRISTUS Health policies, procedures, objectives, quality assurance, safety, environmental and infection control.
Implements job responsibilities in a manner that is consistent with the CHRISTUS Mission and Code of Ethics and supportive of CHRISTUS Healthâ€™s cultural diversity objectives.
Supports and adheres to CHRISTUS Health Service Guarantee.
Performs other related work as required
High school diploma or GED. Working knowledge of ICD9, CPT and HCPCS coding.Â
Knowledge of Medicare, Medicaid and other managed care plan enrollment processes.Â
Ability to operate 10 key calculator by touch. Knowledge of medical software systems.Â Ability to prioritize multiple tasks.
Three years of accounts receivable experience including two years of experience in a health care organization; one year of experience in a managed care setting.Â
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.