Peninsula Community Health Services of Alaska · 2 weeks ago
Provider Enrollment/Billing Specialist - NOT REMOTE
Soldotna, AK
Full-time
Onsite
Mid Level
3+ years expPeninsula Community Health Services of Alaska is seeking a Provider Enrollment/Billing Specialist to ensure the financial well-being of the organization through timely provider enrollment and accurate billing processes. The role involves managing insurance claims, collections, and maintaining accurate records within the electronic health record systems.
Government Administration
Responsibilities
Complete provider and group enrollment for all PCHS sites
Successfully implement the entire enrollment process for all providers, adhering to all timelines while maintaining strict confidentiality for matters pertaining to provider credentials
Effectively communicate with providers to ensure timely completion of outgoing and incoming applications
Complete revalidation of previous enrolled providers and groups
Communicate with insurance payers to resolve provider enrollment issues
Develop a payor contact list and keep current
Develop and maintain a tracking list for provider enrollment
Help the billing department with any payment issues relating to PPO’s we contract with
Maintain Medicaid and Medicare Org numbers: Do updates, etc
Maintain PPO sites for accuracy, changes, etc. This includes Availity, OneHealth Port, Medicare, etc
Provider Billing enrollment in all PPO’s plus Medicare/Medicaid/CAQH
Terminate providers from all Payor sources when they terminate
Monitor aging to ensure timely follow-up of claims resolution, reduction of future denials, ensuring accurate payment, and escalation of issues to management as identified
Conduct insurance re-verification as needed through various tools and initiate billings to a new payer, reprocess the claim accordingly, or bill the patient
Manage collections
Complete VA prior authorizations
Review and appeal unpaid and/or denied claims
Prepare, verify, submit and track prior authorizations, including VA
Verify patient coverage and insurance benefits
Answer patient billing questions
Process insurance and patient refunds
Handle self-pay collection efforts on all unpaid accounts and submit to Collections on a timely basis
Audit data when necessary and/or appropriate
Post payments, adjustments, and denials in systems as appropriate
Balance daily deposits to daily postings for all systems
Keep billing spreadsheets up to date, checking daily
Check allowables to ensure correct payment and account balances
Post zero pay correspondence as pertaining to: deductibles, copayments, and denials
Process credit card payments and balance credit card machine transactions daily
Perform duties as assigned by the CFO
Qualification
Required
High School Graduate
Must pass a State required background check plus a pre-hire drug screen
Preferred
Certified Medical Coder (AAPC or AHIMA)
3-5 years of healthcare claims processing and/or billing/coding experience
FQHC experience
Company
Peninsula Community Health Services of Alaska
Peninsula Community Health Services of Alaska, Inc.
51-200 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase