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Medical Claims Specialist with prior Credentialing experience a must

Location: Fort Pierce
Posted on: January 22, 2023

Job Description:

Please do not apply if you do not have prior credentialing, claims and billing experience, thank you.******* Only local candidates with prior experience in BILLING, CLAIMS AND CREDENTIALING need apply*****MUST HAVE PRIOR EXPERIENCE

Dynix Diagnostix, founded in 2016, is an industry leading, full-service clinical laboratory. We deliver quality service and efficient results for molecular genetics, blood testing and toxicology.At -Dynix Diagnostix -our greatest asset is our people. We offer a friendly environment, competitive wages and a benefits package. We are in growth mode and need to add people to our already dynamic team. If you are interested in joining the best Laboratory on the Treasure Coast, please submit your resume.POSITION SUMMARY: - -This position will be working with Medical Billing/Collections AND Credentialing- - -******* Only local candidates with prior experience in billing, claims and credentialing need apply*****The Medical Billing and Collection Specialist -is responsible for ensuring accurate billing, timely submission of electronic and/or paper claims, monitoring claim status, researching rejections and denials, documenting related account activities, posting adjustments and collections for Insurance, Contract and Private Pay.

  • Major Duties and Responsibilities:
    • -In addition to the major duties and responsibilities listed above, this position will be responsible for special projects and assignments on an as needed basis.
    • Complete required trainings, and additional recommended trainings that can help promote compliance with a variety of employment obligations.
    • -Perform other duties as assigned by department manager.
    • -Prepare, store and retrieve patient health records (commercial and governmental payers).
    • Bill (1500 form) to both commercial and governmental payers.
    • -Identify billing issues and determine the source of the problem to ensure it does not occur in the future.
    • Responsible for working denials from insurances daily.
    • -Verify patient insurance coverage; attain required referrals or authorizations when needed.
    • Understand and participate in all aspects of the billing & collection processes.
      • Ability to lift 40 pounds.
      • Maintains good attendance and punctuality.
      • Actively explores new educational pursuits to improve job knowledge and skills
      • Accepts ownership for all tasks and responsibilities.
      • Excellent organization skills, verbal and communication skills.
      • Positive attitude and team player.
      • -Strives to deliver high-quality results at all times in accordance with standards.
      • Proudly services the company by following all HIPAA, JCAHO, state, and federal laws and standards.
      • Maintains strict confidence of patient, client, company and employee information.
      • Other Criteria:
      • -Prolonged periods of sitting at a desk and working on a computer.
      • Ability to multitask in a fast-paced environment and willingness to adapt to change.
      • Ability to prioritize, meet deadlines and maintain strong working relationships with others, internally and externally.
      • Ability to accurately process high volumes of work within a short period of time.
      • Needs to be familiar with ICD-10, CPT, and/or HCPCS Coding Systems as well as claim form CMS-1500.
      • Ability to apply policies and procedures; performs job safely with respect to others, to property, and to individual safety and works effectively with others.
      • Ability to analyze, evaluate and report data without oversight.
      • -Ability to process high volumes of work, without errors.
        Credentialing -This position is primarily responsible for initiating and maintaining state and commercial payor credentialing - all states where Dynix Diagnostix, LLC currently practices. This individual will work closely with - enrollment and licensing to effectively navigate a variety of complex state and/or federal policies and requirements, which is critical to the operation of our medical laboratory.
        • Major Duties and Responsibilities:
          • Initiate and maintain credentialing for all locations
          • Communicate adverse, incomplete, or questionable data to designees and recommend appropriate course of action.
          • Initiate and maintain payor enrollment. - -
          • Prepare initial credentialing and re-credentialing files to be presented to the C.O.O in a timely and expeditious manner
          • Initiate and maintain provider services payor enrollment as assigned
          • Ensure accuracy and completeness of provider services - applications whether state or private
          • Provide regular updates to the payors of changes in billable provider demographics, practice locations, name changes, etc. -
          • Maintain accurate and concurrent updates for each location to reflect the history of a organization's credentialing and enrollment status
          • Resolve complex issues relating to provider credentialing
          • Respond to requests by external and internal entities regarding issues pertaining to the status of credentialing and/or enrollment of organization. -
          • Prepare for re-credentialing applications on all services and locations
          • Other duties upon request
            • Comprehensive knowledge of medical, clinical, and payor (both commercial and managed care) credentialing regulations and process
            • Strong organizational skills, detail-orientation with the ability to prioritize
            • Time management skills in a fast-paced environment
            • Excellent Analytical skills to problem solving
            • Strong communication both written and verbal
            • Problem solving skills and ability to explore all options and use available resources to find new and effective solutions
            • Strong organizational, critical thinking and problem-solving skills required
            • Ability to communicate appropriately and effectively with providers; including sensitive and confidential information
            • Must be able to prioritize and meet deadlines on an ongoing basis to ensure timely completion according to process requirements
            • Exhibits sound judgment and one who hold themselves up as a role model and mentor Requirements:EDUCATION AND/OR TRAINING: High School Diploma or GED. Associate degree desired.EXPERIENCE:******* Only local candidates with prior experience in billing, claims and credentialing need apply*****

              • 1 year of Medical billing.
              • Medicare Claims and Commercial Insurance Claims.
              • Knowledge / familiarity with medical terminology.
              • MicrosoftCredentialing
                • 1 + year of years of technical training and 3+ years experience preferably with commercial, Medicaid Managed Care, and other payor credentialing.
                  Physical Demands and Work Environment: -Physical demands: -While performing duties of job, incumbent is occasionally required to stand for full shift; walk; sit; use hands to handle, or feel objects, tools, or controls; reach with hands and arms; talk and hear. Employee must occasionally lift and/or move up to 35 pounds. -Work environment: -A/C work area, the noise level is usually moderate.Additional Information:We are looking for dedicated people who wants to grow with our company.Dynix Diagnostix does not accept applications, inquiries or solicitations from unapproved staffing agencies or vendors.Equal Opportunity Employer: Minorities/Women/Protected Veterans/DisabledEEO is The Law

Keywords: DYNIX DIAGNOSTIX LLC, Fort Pierce , Medical Claims Specialist with prior Credentialing experience a must, Healthcare , Fort Pierce, Florida

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