Credentialing Coordinator

A large, multi-specialty surgical group in Westchester is seeking an Accounts ReceivableCredentialing Representative on a temp-to-hire, or direct hire basis. This position will be fully onsite, Monday through Friday, 9am - 5pm. Our client is seeking candidates who have experience with Provider Credentialing and will provide training on their Accounts Receivable functions.RESPONSIBILITIES:Serving as a liaison between practice, credentialing company, and newcurrent providers; obtaining all necessary information to complete insurance credentialing, current hospital credentialingprivileges and re-credentialing status, ensure applicable fees and permits are issued and kept current, submit current malpractice liability certificatesOrganize, file, maintain detailed records of all credentialing and receivables information in designated drives, EMR, andor other systemsAnalyze EOB information, co-pays, deductibles, co-insurance, contractual adjustments, underpayments and denial reasons.Review, follow up and respond to inquiries via email, phone or incoming correspondence in a timely manner to resolve outstanding balances, patient complaints or questions regarding the billing processReview patient account balances to ensure all patient payment are applied appropriately.REQUIREMENTS:Experience obtaining the initial status of medical claims by calling insurance carriers andor checking online web portalsExperience with follow up via carrier communication through phoneonline web portals to resolve issues and ensure claims are paid timely and appropriatelyExperience resolving denials and submitting appeals: Identify and resolve denials and payment variances and act to resolve issues through claims reprocessing, claim corrections, andor drafting and submitting reconsiderationsappealsProficiency in Microsoft Office Suite including Outlook, Word, Excel and OneDriveKnowledge of CPTICD10, medical terminologyFamiliarity with EMR systems preferably Centricity, ModMed or equivalentHigh level of customer service & interpersonal skills to work effectively with insurance companies, patients, physicians, and other team members in the practicehigh level of accuracy and attention to detail, well-organized, self-motivated, and ability to multi-task while working in a fast-paced environment to meet various deadlinesAbide by HIPAA and any state and federal laws to remain complaint in accordance with practice policies and proceduresAbility to read and interpret explanations of benefits, insurance denials, partials payments, adjustments, and recoupments

Created: 2025-02-21