Credentialing and Reimbursement Assistant Manager
EMERGICON LLC
Terrell, Texas
This position is responsible for assisting with the overall management and leadership of the Credentialing and Reimbursement Departments. This position will ensure accurate and timely credentialing, investigate payer setup issues, and is responsible for the training and development of the team.
ESSENTIAL DUTIES AND RESPONSIBILITIES
• Ensure timely, efficient, and accurate credentialing and reimbursement of all clients
• Develop credentialing and reimbursement workflows, protocols, and procedures
• Identify, and act on, opportunities to improve credentialing and reimbursement activities
• Develop and maintain processes making provider statuses readily available to Operations
• Monitor and review payer set up and establish action plans to resolve issues
• Track license and certification expirations for all providers and ensures timely renewals
• Monitor daily communications with Medicare, Medicaid, and commercial insurance companies to ensure updates are completed timely
• Maximize ERAs and EFTs to ensure efficiency
• Handle onboarding - Money Flow, Banking, EOM funds
• Prepare and manage money flow calls with clients
• Manage missing EOB log and Commercial Banking Projects
• Stay updated on industry and legislative changes
• Monitor Freshdesk tickets for reimbursement and credentialing
• Other job-related duties as assigned
KNOWLEDGE AND EXPERIENCE PREFERRED
• Bachelor’s degree or equivalent education and experience
• Minimum of three (3) years Texas Medicaid and Medicare Part B Ambulance credentialing experience.
• Fluency on the following websites: CMS, NPPES, DSHS, TMHP, and PALMETTO GBA, PECOS, Dept of Labor, SAM, NAVINET
• Minimum of three (3) years of Texas Medicaid, Medicare Part B, and commercial payer EDI/ERA/EFT and portal set-up experience
• Knowledge of federal and state insurance laws and their interpretation
• Knowledge of Microsoft Excel
• Ability to work within a deadline-intense environment, with strong adaptability to change
• Demonstrated problem-solving and professional customer service skills
• Ability to communicate effectively and professionally
• Detail oriented, organizational and time management skills
• Ability to prioritize and multi-task
• High School Diploma/GED required
Emergicon requires satisfactory pre-employment drug screen and background check.
EMERGICON LLC is an EEO employer - M/F/Vets/Disabled