Billing and Credentialing Specialist

Description

The Billing and Credentialing Specialist is responsible for managing the billing and reimbursement processes for Applied Behavior Analysis therapy services and overseeing the credentialing process for all Adapt for Life billable staff members. This role involves working closely with insurance companies, clients, and internal staff to ensure accurate and timely submission of claims, verification of insurance coverage, resolution of billing issues, and submission of required credentialing forms. The ideal candidate will have a strong understanding of insurance billing procedures, excellent communication skills, and the ability to navigate complex insurance systems.

This is a full-time, salaried position with competitive pay, PTO, and full health insurance benefits. 

Requirements

Must have clean criminal background checks.

• Must be available to work Monday-Friday, between the hours of 8am and 5pm. 
• This position may require work outside of normal business hours.
• This position may periodically or primarily work from home. 
• Knowledge of insurance procedures, coding systems, and billing regulations.
• Must demonstrate excellent time-management, punctuality, and reliability. 
• Must have excellent organizational skills.
• Must be able to work and complete tasks under little supervision. 
• Must be fluent with various funding sources (i.e. private insurance companies, Medicaid) in order to properly bill for rendered services.
• Must be dedicated to and supportive of the growth and success of Adapt for Life. 

Responsibilities:

• Claims Submission:
• Prepare and submit accurate insurance claims for ABA therapy services rendered.
• Verify and enter all necessary patient information and treatment details into the billing system.
• Ensure compliance with insurance requirements and guidelines.
• Insurance Verification:
• Verify insurance coverage and eligibility for ABA therapy services.
• Communicate with insurance companies to obtain pre-authorizations and ensure timely approval of services.
• Billing Documentation:
• Maintain detailed and organized billing records, including treatment plans, authorizations, and other relevant documentation.
• Review and update patient records to reflect accurate billing information.
• Reimbursement Management:
•  Monitor and track the status of insurance claims to ensure timely reimbursement.
•  Investigate and resolve claim denials, rejections, and other billing issues.
•  Communicate with insurance companies to resolve payment discrepancies and appeal denied claims.
• Communication:
• Collaborate with ABA therapists, administrative staff, and clients to obtain necessary information for billing purposes.
• Provide clear and concise communication to clients regarding their insurance coverage and billing inquiries.
• Coding Compliance:
• Stay informed about current coding guidelines and ensure accurate application of CPT and ICD-10 codes.
• Attend training sessions to stay updated on changes in insurance regulations and billing procedures.
• Reporting:
• Generate and analyze reports related to billing and reimbursement metrics.
• Provide regular updates to management regarding the status of outstanding claims and key performance indicators.
• Credentialing
• Work with hiring managers to collect, process, and submit required credentialing forms and documents for newly hired clinical staff.
• Create and manage provider’s CAQH and complete 120 day re-attestations to ensure information is kept up to date with. 
• Obtain NPI’s for any providers that may need one. 
• Complete annual provider maintenance to ensure provider’s demographic information is up to date with all payers. 
• Complete provider disenrollment for providers no longer with the company.