Coastal Health & Wellness is Galveston County's Community Health Center, with clinics in Texas City and Galveston. We also service TCISD students and employees. First established in 1970 and then called Galveston County Coordinated Community Clinics (4C's), we provide high quality healthcare to all - offering primary care, prenatal, dental, and behavioral health counseling services.
RCM provides task-based coding, billing, and collection support to CHW and various Galveston County Health District (GCHD) partners. This includes standard, highly reliable, team-oriented, daily work with payors including Medicare, Medicaid, Medicaid Managed Care, Commercial Insurance as well as County Indigent and Self-pay patients in NextGen EPM/EHR/EDR.
The CHW Revenue Cycle Management Enrollment Specialist is a core contributor to the health & integrity of CHW's revenue cycle performance. This team member is responsible for the timely and accurate enrollment of medical providers with all required insurance payers as well as credentialing/re-credentialing of all employed Coastal Health & Wellness physicians and contracted affiliated providers. The functions include but are not limited to initial and re-credentialing applications, and tracking of all applications, primary source verifications, file production and maintenance, presentation at Credentialing Committee, internal and external communication of outcome reporting, liaison with designated payors regarding the enrollment and/or of credentialing/re-credentialing status of providers.
We can offer you:
Excellent Benefits; including an Amazing retirement package, Paid Time Off plans, Affordable Medical Insurance, FREE Life Insurance, FREE Long-Term Disability, FREE Parking and much more!
Team Oriented Environment
Hourly Rate: $20 actual offer will be commensurate upon related experience & education
We want you to join our team of professionals! If you meet the criteria listed below, please apply.
Required: Graduation from an accredited high school or equivalent.
2+ years of experience in a medical, dental and/or behavioral health provider licensing, credentials, and payor records.
History working with Medicare, Medicaid, and private insurances required.
NextGen EPM & FQHC and billing experience preferred.
Strong team player who intentionally invests in the development of others and identifies/closes knowledge gaps.
Capable and competent time management, multi-tasking acumen
Excellent written & interpersonal skills.
Bilingual in Spanish preferred.
Understanding of medical terminology and coding & billing compliance laws, regulations, policies, and guidelines.
Customer experience-oriented professional with demonstrated performance history and commitment.
Advanced skills Microsoft suite of products; Outlook, MS Office (MS Excel & MS Word) - SharePoint experience a plus.
Must be compliant with GCHD Immunizations policy and ICS training requirements.
Must pass criminal background check and drug/alcohol screening.
Must be willing and able to work evening and weekend hours, as necessary.
Must possess or ability to readily obtain a valid driver's license issued by the State of Texas for the type of vehicle or equipment operated.
Department of Motor Vehicle check may be required, if applicable.
An equivalent combination of education and work experience which appropriately demonstrates the knowledge, skills and abilities to perform the above described essential functions will be considered when hiring for this role.
Traditional Duties: Create and maintain licensing, credentials, and payor records.
Conduct research on updated state and federal regulations and policies.
Release information to requesting agencies and public inquiries when required by law.
Monitor license and credential expiration dates and advise providers of required "renew by" dates.
Maintain an active knowledge of industry standards and requirements regarding medical billing and payer enrollment, including specific payer requirements.
Must have a working knowledge of enrollment /Credentialing with Medicare, Medicaid, and all traditional and state-funded insurance plans.
Credential / enroll new hires with all required payers.
Must be organized and able to track credentialing re-applications when they are due.
CAQH Maintenance
Work with the billing department to assist with rectifying outstanding claims for third party payers.
Maintain compliant billing practices and ensure that federal, state, and local laws and guidelines are followed accordingly.
Work in conjunction with facility credentialing to manage up to date credentialing status at all sites of service for the organization.
Work with clinical team to keep their information current.
Monitor out of network claims in NextGen EPM.
Analyze and interpret claim reimbursement and patient account and claim-level transactions.
Assist with payor audit related requests.
Process payment transfers and refunds to payors, State of Texas, patients and/or guarantors.
Attend all staff in-services, provider meetings, workshops, and training, lead as appropriate.
Communicate with cross-functional, internal & external teams to identify & resolve billing and/or payment issues.
Answer/respond to incoming calls, portal inquiries, askRCM, NextGen tasks, emails and other correspondence related to patient accounts by deploying active listening. And prompt responses.
Communicate daily with internal and external customers via phone calls, EPM/EHR tasks and written communication.
Identify trends, and payor issues related to billing and reimbursement; report and/or escalate to RCM management.
Research, document findings, and communicate professionally, respectfully, and effectively with all stakeholders.
Maintain patient confidentiality and protect GCHD/CHW operations by keeping patient information confidential.
Prepares and ensures accuracy of all reports to management, consultants, payors, and other 3rd parties, as appropriate.
Exercise independent judgment based on CHW Policy and compliant billing best practice.
Perform other duties as assigned by management.
No Phone Calls Please
ADA/EEO/DFWP
Our Mission: Protecting and Promoting the One Health of Galveston County
