ABOUT LIGHT COUNSELING:Since 1991, Light Counseling has served thousands Individuals, Couples, & Families with professional, confidential, and distinctly Christian counseling services in Virginia and fourteen (14) other states! We take pride in incorporating God's truth in the helping process. Our mission is to bring hope to the hopeless and healing those who are hurting by helping individuals realize their God-given, divine potential.DESCRIPTIONWe are seeking a highly organized and detail-oriented Provider Enrollment and Billing Specialist to join our team. The ideal candidate will be responsible for ensuring the timely and accurate enrollment of mental health providers with insurance companies, maintaining compliance with credentialing requirements, and managing the billing process to optimize revenue cycle performance. This position plays a vital role in supporting the financial and operational success of the practice.client payments, answering inquiries via in-person, phone, or email settings; and scheduling and rescheduling sessions.LEVEL OF RESPONSIBILITY:Employment with Light Counseling is of a confidential nature and operates in accordance with federal and state privacy laws and practices (i.e. HIPAA). All work is performed under supervision, but does require the ability to effectively function independently, with flexibility, initiative, maturity and decision-making within the framework of Light Counseling policy and procedures. DUTIES AND RESPONSIBILITIES: Provider Enrollment and Credentialing:
- Coordinate and complete the enrollment process for new and existing mental health providers with insurance companies, Medicare, Medicaid, and other payers.
- Maintain and update provider profiles in CAQH (Council for Affordable Quality Healthcare) and PECOS (Provider Enrollment, Chain, and Ownership System).
- Monitor credentialing expirations, proactively ensuring all certifications, licenses, and insurances remain current.
- Manage re-credentialing requirements and ensure providers maintain active status with all payers.
- Serve as the primary liaison between providers and insurance companies, troubleshooting and resolving enrollment and credentialing issues.
Billing and Revenue Cycle Management:
- Oversee the submission of accurate and timely claims to insurance companies for mental health services rendered.
- Post remittances and payments accurately in the billing system and reconcile discrepancies.
- Prepare and send patient statements for outstanding balances, ensuring clarity and accuracy.
- Verify insurance benefits and eligibility for clients, including pre-payment verification, to ensure coverage and reduce the risk of denials.
- Review Explanation of Benefits (EOBs) and remittance advice to ensure proper reimbursement and resolve discrepancies.
- Manage accounts receivable, including follow-up on denied or unpaid claims and ensuring timely collections.
- Collaborate with the billing and clinical teams to ensure accurate coding and documentation for claims submission.
Compliance and Process Improvement:
- Stay informed on changes to payer requirements, billing guidelines, and industry regulations to maintain compliance.
- Develop and maintain Standard Operating Procedures (SOPs) for enrollment and billing processes.
- Identify opportunities to streamline processes and improve efficiency in enrollment and billing workflows.
Communication and Collaboration:
- Work closely with clinical providers, administrative staff, and billing teams to address issues related to credentialing, claims, or payments.
- Provide regular updates to management regarding enrollment status, billing metrics, and outstanding claims.
- Educate providers and staff on best practices for documentation and billing compliance.
The Provider Enrollment and Billing Specialist is an integral part of the team and must be willing to not only be flexible, but also learn and accept new responsibilities, work well with others, and contribute to the mission and values of Light Counseling. The Provider Enrollment and Billing Specialist must represent Light Counseling to all clients in a manner that reflects its values.MINIMUM QUALIFICATIONS
- High School diploma or equivalent. Bachelor's Degree or equivalent related work experience, preferred
- Minimum of 2 years of experience in provider enrollment, medical billing, or credentialing, preferably in a behavioral health or mental health setting.
- Strong knowledge of insurance processes, including Medicare, Medicaid, and commercial payers.
- Proficiency in medical billing software and electronic health records (EHR) systems.
- Excellent organizational skills with a high attention to detail and accuracy.
- Strong communication and problem-solving skills, with the ability to work collaboratively in a team environment.
- Experience with behavioral health credentialing preferred
- Strong attention to detail
- Moderate computer proficiency
- Excellent oral and written communication skills.
- Valid Driver's License and acceptable driving record.
- Be proficient with Microsoft Office 365
- Complete all required background checks and drug testing.