Credentialing and Billing Specialist
JEFFERSON BLOUNT ST CLAIR MENTAL HEALTH AUTHORITY
Summary
The Credentialing/Billing Specialist is responsible for insurance credentialing and recredentialing, managing claim submission and denials, and insurance verification processes for outpatient mental health services. This role will be instrumental in our initial efforts to be eligible to bill Medicare, Blue Cross, Viva, and other new payer sources. They are to ensure JBS compliance with federal and state regulations, accreditation standards, payer requirements, and organizational policies. The specialist works closely with Human Resources, Program Directors, insurance payers, and regulatory agencies to maintain accurate provider records and timely enrollment.
Job description
Essential Duties & Responsibilities
- Key figure in Medicare and commercial payers initial provider enrollment and credential process.
- Manage provider credentialing and recredentialing processes with Medicaid, Medicare, and commercial payers.
- Ensure all provider credentials are up to date and compliant with insurance company requirements.
- Validate and maintain provider credentials, including: Medical licenses, DEA registrations, Board certifications, Education and training, work history, Malpractice insurance coverage, and other required documentation.
- Monitor expiration dates and ensure timely renewals of licenses, certifications, and other pertinent information.
- Coordinate provider enrollment and revalidation with Medicare, Medicaid, and commercial insurance carriers.
- Respond to payer requests and resolve credentialing matters.
- Prepare reports for leadership regarding credentialing status and compliance metrics.
- Maintain confidentiality and HIPAA compliance in all credentialing activities.
- Assist with audits and accreditation reviews.
- Perform electronic billing and claims processing for non-Medicaid clients on a routine basis.
- Process and post incoming payments for non-Medicaid claims.
- Review, analyze, and resolve denied or underpaid non-Medicaid claims in a timely manner.
- Track and follow-up on outstanding non-Medicaid claims and correct any errors to secure payment.
- Prepare and submit appeals for denied claims, ensuring compliance with payer guideline.
Knowledge, Skills & Abilities
- Knowledge of provider credentialing and payer enrollment processes.
- Knowledge of CPT codes, ICD-10 coding, and mental health billing regulations, including prior authorization processes.
- Familiarity with Medicare, Medicaid, and commercial payer requirements.
- Strong attention to detail and organizational skills.
- Excellent written and verbal communication skills.
Qualifications
Education: High School Diploma or GED required. Associate's or Bachelor's degree in Healthcare Administration, Business Administration, or related field preferred.
Experience: 2–3 years in medical billing, with a focus on mental health services. 1 year experience in insurance credentialing, provider enrollment, and payer requirements.
Certifications (Desired): Certified Provider Credentialing Specialist (CPCS); Certification in Medical Billing and Coding (CPC, CPB, or similar).
Requirements
- High School Diploma or GED required
- 2–3 years in medical billing, with a focus on mental health services
- 1 year experience in insurance credentialing, provider enrollment, and payer requirements
- Knowledge of provider credentialing and payer enrollment processes
- Knowledge of CPT codes, ICD-10 coding, and mental health billing regulations, including prior authorization processes
- Familiarity with Medicare, Medicaid, and commercial payer requirements
- Strong attention to detail and organizational skills
- Excellent written and verbal communication skills
Company overview
The Jefferson Blount St Clair Mental Health Authority is a regional government agency responsible for coordinating and providing comprehensive mental health services across Jefferson, Blount, and St. Clair counties in Alabama. As a public mental health authority, it operates under state regulations to ensure accessible mental health care for residents in its service area. The organization typically oversees a range of services including crisis intervention, outpatient counseling, substance abuse treatment, case management, and community-based support programs. These authorities play a crucial role in bridging the gap between state mental health policies and local community needs, often working with various healthcare providers, social service agencies, and community organizations to create integrated care systems. The authority focuses on serving vulnerable populations, including individuals with serious mental illnesses, developmental disabilities, and substance use disorders, while also providing prevention and early intervention services to promote community mental wellness.