Billing/Payer Enrollment Specialist (62781)

**Our Mission, Vision, & Model of Care** At Union Community Care, our purpose is at the forefront of all that we do: we stand for whole health to help you live your fullest life. We envision vibrant and healthy communities supported by inclusive healthcare that embraces each member’s unique culture, needs, and values, and emboldens them to make healthful choices that fuel their well-being and the well-being of others. We believe in whole health. This means we address and heal disease but equally important, we work at the causes of the causes, the social ills that must be addressed to achieve true equity. We listen, learn, and embrace the complex lives and unique strengths of our patients, and we work hard to break down all barriers to care. This means we look through a grassroots lens. We connect with our communities because we are our communities. Each of us is a neighbor, a friend, a family member, and together, we are a trusted community health center. **Job Duties:** 1. Completing all initial payer enrollment applications for commercial and government payers and completing timely follow up. 2. Completing and maintaining all CAQH profiles for all providers 3. Ensuring that re-credentialing and revalidations are completed timely to prevent any lapse in enrollment 4. Maintenance of credentialing and billing information in the Credentialing enrollment system 5. Communicating with payers, providers, and other entities to quickly and accurately obtain or provide information beneficial to the credentialing or enrollment needs of the organization 6. Maintaining knowledge of current health plan and agency requirements for credentialing 7. Ensuring practice addresses are current with government and commercial health plans, agencies and other entities 8. Maintaining confidentiality of provider information 9. Terminating enrollment with government and commercial payers upon resignation or termination of providers 10. Updating and maintaining National Provider Identification files for locations 11. Using the electronic billing system, along with any of the organization’s proprietary spreadsheets or software, purchased or leased, as the primary source of immediate notification and maintenance of enrollment related data 12. Responding to the enrollment services dashboard tasks and overall maintenance and content 13. Communicating with Athena Health Enrollment Services as needed both verbally or through tasks and cases 14. Monitoring worklists to identify increases in accounts receivable or claims denials related to enrollment and credentialing issues, and working toward resolution 15. Collaborate with Billing Specialist on any issues related to payer enrollment. 16. Processes and posts insurance payments along with patient payments in an accurate and timely manner in accordance with Union Community Care’s policies, procedures and performance goals. 17. Coordinates with PAS to ensure accurate patient information for billing purposes 18. Performs a variety of general clerical duties, including telephone reception, mail distribution, and other routine functions. 19. Works Claim Holds and Denials by investigating (calling), correcting and resubmitting claims to third party payers 20. Answers questions from team members, patients and insurance companies 21. Maintains patient demographic information, including insurance eligibility and benefit verification 22. Participates in educational activities and attends staff meetings 23. Maintains strict confidentiality and adheres to all HIPAA guidelines and regulations 24. Performs other work-related duties as assigned **SPECIFIC JOB DUTIES- Billing Team Lead** 1. Performs all duties of Billing/Payer Enrollment Specialist 2. Works with Billing Specialists to research appropriate billing & coding procedures 3. Works with Director of Billing to maximize revenue potential based on our unique services and providers 4. Works with Director of Billing to maximize department efficiency 5. Assists with recon…