ABA Building Blocks, LLC is the premiere provider of business services for ABA/Autism and special needs agencies. We pride ourselves on providing our clients with exceptional customer service.
The Contracting and Credentialing Specialist supports the billing department in all areas of revenue cycle management including contracting and credentialing, rate negotiations, national contracting, provider credentialing, enrollment in ERA/EFT/EDI, maintaining industry knowledge relating to nationwide and state specific regulations for ABA and related specialties, and adhering to company policies and procedures.
To succeed in this role, the Contracting and Credentialing Specialist must possess in-depth knowledge of the revenue cycle process and the ability to quickly learn the nuances and codes of ABA/autism billing as well as the various EHR systems and online payer portals used in the ABA industry. The ideal candidate must also be able to demonstrate excellent written and verbal communication skills, as communicating with clients and various insurance agents will form a large part of the job. In this position, you will be responsible for a variety of tasks requiring data analysis, in-depth evaluation, multi-tasking and sound judgment.
Job responsibilities include but are not limited to:
Specialist duties
- Gather the necessary licensure info and documentation needed for contracting and credentialing providers with payors.
- Maintain records and manage provider profiles with external payor portals and databases (NPPES, CAQH, etc.)
- Submitting contracting applications
- Submitting credentialing applications
- Submitting demographic updates
- Provider validations (via various provider portals as requested by clients)
- Prepare rate negotiation proposals
- Ability to build strong rapport with providers and insurance representatives
- Payer recommendations based on geographic location and experience
- Bi-Weekly/Monthly update emails and meetings with clients (as requested)
- NPPES and CAQH walk-throughs with providers
- Follow up on submitted apps, demographic updates, rate negotiations (phone calls, emails, portals)
- Communicate approvals and status updates to providers and leadership and maintain information in client management system to allow staff to bill properly.
- Work closely with the billing team to identify and resolve any denials or authorization issues related to provider credentialing.
- Keep internal trackers up to date
- Maintain up to date knowledge of industry trends
- Other duties as assigned within the department
Requirements:
- A minimum of 2 year of experience in contracting and credentialing.
- Solid understanding of insurance billing workflow
- Must have the ability to multitask and manage time effectively
- Excellent written and verbal communication skills
- Outstanding problem-solving and organizational abilities
- Team player
- Exceptional customer service
- Experience with technology and Microsoft 365 platform.
Preferred:
- Experience working in the ABA/Autism industry as a C&C Specialist
- Experience with OT/PT/Speech contracting and credentialing
- Experience working in Billing/Authorizations in addition to C&C
- Familiar with ABA CPT Codes and the BCBA credentialing process
Job Type: Full-time
Pay: $18.00 - $22.00 per hour
Benefits:
Schedule:
Application Question(s):
- MOST Anthem BCBS submissions nationwide are submitted through what website?
- What online application does every behavioral health provider have to have completed, in order to credential with insurance companies?
- What are the states that you have credentialing & contracting experience in?
- How do you feel about working in a remote online group environment?
- You have 15 groups you are responsible for. How would you make sure that all applications are processing smoothly?
- How long does it normally take you to be able to start your role independently when starting at a new company?
- How would you prioritize the below tasks given in one day? (Number the following choices): a) You have 2 submissions due b) A client sent an urgent email c) Management messaged you with a task to complete
- What is your work style? (Choose one of the following): a) I work better when someone is constantly double checking my work b) I work better independently with no support c) I work better when I have a supportive team that I can go to when I have questions
- You submitted an LOI on the website and haven't heard back from the payer, what are the next steps?
- What tools do you utilize to track the status of submissions?
- What would make ABA Building Blocks a good fit for you?
- What is the national provider identifier website called?
- What is your experience with communicating to providers regarding the status of their applications?
Experience:
- Contracting and Credentialing: 2 years (Required)
- Applied Behavior Analysis CPT codes and BCBA credentialing: 2 years (Preferred)
Work Location: Remote