Position Summary: Coordinates Medicare and Medicaid enrollment/re-enrollment and managed care credentialing and contracting processes for providers. Serves as administrator for billing system and assists practices with system issues. Maintains NPI files and provider numbers. Serves as customer service liaison. Monitors accounts receivable to maintain appropriate levels and reviews payments to maximize reimbursement. Interacts with patients, insurance carriers, the billing vendor and practice personnel concerning patient accounts. Performs all functions in a courteous and professional manner.
Provider Enrollment 1. Collects and maintains data on providers for Medicare and Medicaid enrollment.
2. Prepares and submits applications to Medicare and Medicaid for new provider enrollments and existing provider updates; follows up by telephone or in writing, with carriers regarding application status.
3. Complies with Medicare and Medicaid provider enrollment guidelines.
4. Requests NPI numbers for providers and clinics as necessary and maintains NPI files.
5. Follows up, either by telephone or in writing, with insurance companies and patients regarding the processing of outstanding claims and/or appeals.
6. Generates various reports to identify outstanding claims issues with provider numbers and non-payment.
7. Communicates information to appropriate personnel. Educates staff on corrections, e.g. front-end entry errors in a positive, constructive manner.
8. Collects and reviews managed care contracts for correct billing and payment terms.
9. Identifies problem accounts and follows through to completion.
10. Reviews Athena correspondence and unpostables.
11. Participates in company sponsored enrollment/credentialing meetings and other educational activities.
12. Participates in Billing System Training exercises and updates.
13. Assists in training on the Billing System software package when necessary.
14. Serves as a Superuser of the Billing System to be available to answer questions from the various clinics
15. Follows the CHRISTUS Physician Group guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI).
16. Maintains strict confidentiality.
17. Uses oral and written communication skills to effectively convey ideas in a clear, positive manner that is consistent with the CHRISTUS Mission.
18. Maintains established CHRISTUS Physician Group policies, procedures, objectives, quality assurance, safety, environmental and infection control.
19. Implements job responsibilities in a manner that is consistent with the CHRISTUS Mission and Code of Ethics and supportive of CHRISTUS Physician Group's cultural diversity objectives.
20. Supports and adheres to CPG Service Guarantee.
Our Mission: WHY WE EXIST. To extend the healing ministry of Jesus Christ. Our Core Values: WHAT WE BELIEVE IN.DIGNITY Respect for the worth of every person, recognition and commitment to the value of diverse individuals and perspectives, and special concern for the poor and underserved. INTEGRITY Honesty, justice, and consistency in all relationships. EXCELLENCE High standards of service and per...formance. COMPASSION Service in a spirit of empathy, love, and concern. STEWARDSHIP Wise and just use of talents and resources in a collaborative manner.Our Vision: WHAT WE ARE STRIVING TO DO. CHRISTUS HEALTH, a Catholic health ministry, will be a leader, a partner and an advocate in the creation of innovative health and wellness solutions that improve the lives of individuals and communities so that all may experience God's healing presence and love. Our Name and Symbol:WHO WE ARE. CHRISTUS is Latin for "Christ," and proclaims publicly the core of our mission. OUR NAME choice also recognizes the heritage of our two congregational sponsors, the Sisters of Charity of the Incarnate Word in Houston and San Antonio. Jesus Christ is the Incarnate Word, the Word of God made flesh. It is, therefore, only fitting that it is in another form of His name that our health ministries are called together. OUR SYMBOL Reflects the healing ministry of Jesus Christ - a combination of a medical cross and a religious cross. The flowing banner on the cross is a common symbol of the risen Christ, while the royal purple signifies Christ. The flowing banner also conveys a sense of motion as we move forward into a new era of service to our communities.