Billing and Credentialing Specialist

Location: Albuquerque or Santa Fe, NM.

Type of Employment : Full-Time with Benefits (health, vision, dental, vacation, holidays, plus five mental health days per year and 401k after one year of service) 

Salary: $60,000- $72,000 annually, based on experience and specialized skills (such as bilingual abilities or behavioral health billing). Opportunities for advancement in salary and responsibilities are available.

Work Schedule: Weekdays, primarily some flex scheduling possible

· Health care benefits for full-time employees are paid at 65% of the cost (these rates can vary year to year as we negotiate contracts with our insurance carrier).

· Two weeks of paid vacation per year 

· Thirteen paid holidays per year 

· Paid sick leave 

· Five mental health days per year 

· Participation in our 401K Plan, after one year of service during one of two enrollment periods.

Required Qualifications and Skills 

High School Diploma or higher is required.

• At least 2 years of medical billing experience, preferably in a behavioral health or outpatient  setting, required.
• Certification as a Medical Biller and Coder is preferred.
• Effective written and verbal communication skills.
• Ability to complete and submit documentation of services and other paperwork in a timely manner.
• Comfort and familiarity working with a diverse client base.
• Proficient in the use of standard office technology (computers, email, etc.) and Electronic Health Record systems.

Personal Qualities

• Well organized
• Able to communicate and work effectively with a team
• High level of integrity and honesty
• High degree of emotional and relational intelligence
• Customer service/client orientation
• Proactive and able to anticipate the needs of the CEO and organization
• Responsive to evolving business needs and priorities

Responsibilities and Duties

Revenue Cycle Management

Prepare, review, and submit insurance claims accurately and promptly.

• Track claims throughout the payment process and resolve rejections or denials.
• Monitor and reconcile insurance and client payments, ensuring all revenue is properly recorded.
• Assist with payment recovery  and follow up on outstanding balances.
• Track payments.

Credentialing and Eligibility

• Assist with provider  credentialing and re-credentialing for insurance panels.
• Verify client insurance eligibility and benefits prior to appointments as needed.
• Maintain organized and up-to-date records for credentialing and billing documentation.

Client Financial Coordination

• Communicate with clients about account balances and billing questions.
• Establish and manage payment plans according to clinic policies.
• Provide outstanding customer service when discussing financial options and resolving billing issues.

Administrative Support

• Build and maintain positive relationships with insurance provider representatives.
• Answer phone calls and assist clients and staff with billing inquiries.
• Provide coverage for scheduling staff as needed.
• Maintain compliance with HIPAA and confidentiality standards.

Professional Development

• Complete all required training for Serna Solutions.
• Review and comply with all state regulations, code of ethics, and insurance protocols relevant to the position.
• Participate in ongoing training and professional development opportunities.

Adhere to all company policies and ensure you stay updated with any new policies as required during