Health Care Practice Manager

Health Care Practice Manager Job Description:

We are seeking a highly skilled Administrative Assistant with credentialing, and medical billing expertise to support our team, ensuring smooth operations in scheduling, credentialing, billing, and insurance verification.

Job Responsibilities:

Administrative Support:
• Patient Coordination: Perform patient registration, appointment scheduling, and follow-ups.
• Provider Support: Assist healthcare providers with documentation, updating medical records, and organizing patient data.
Credentialing Management:
Oversee the credentialing process for providers with Medicaid, commercial insurers, and other governmental agencies to ensure timely enrollment and active status.
Develop & Implement Action Plans to Improve Key Performance Indicators including:
•Increase number of completed group insurance applications to cover all 50 states.
•Optimize applicant tracking system for provider credentialing.
•Optimization of in-house sourcing, lead generation, and connections to behavioral health insurance panels
•Provide day-to-day oversight for group and provider credentialing process, including
- Submit and verify receipt of the credentialing applications to designated health plans.
- Follow up on the application with designated health plans.
- Document receipt of the requested information by the designated health plan.
- Conduct follow-up activities, and document acceptance or rejection information from the health plan.
- Create or modify the Client’s CAQH database, and NPI Registry, or apply for Telehealth licensure under the Interstate Medical Licensure Compact (IMLC).
- Manage weekly or monthly standardized reporting to be shared with senior leadership relating to credentialing success and strategic initiatives. Present these findings weekly or as needed to management team or operational teaUpgrade to see actual infoetings
Contracting Management:
• Maintain up-to-date contract files, ensuring that all necessary documentation is accurate and easily accessible.
• Oversee the contract process from initiation to completion, ensuring proper execution and adherence to terms.
• Serve as a liaison with contracted agencies, addressing any concerns or questions and ensuring smooth communication between the parties.
• Assist in audit preparation, providing requested documentation and keeping leadership informed of any changes that may impact operations.

General Administrative Tasks:

• Manage emails, coordinate virtual meetings, and support day-to-day office operations.
Medical Billing & Insurance Support:
• Medical Billing Expertise: Process claims accurately, ensuring correct CPT, ICD-10, modifier, and place of service coding.
• Insurance Verification & Eligibility: Verify patient benefits, determine correct payers, and confirm provider network participation.
• Claims Management: Create claims from EMR or Superbills, resolve clearinghouse rejections, and follow up on claim status and appeals.
• Payment Posting & EOB Review: Post payments, review Explanation of Benefits (EOBs), and ensure accurate provider reimbursements.
• Contract Verification: Verify providers’ contracts, network participation, and contract fee schedules to ensure correct payment.
• Provider Registration & EFT Setup: Assist with ERA (Electronic Remittance Advice) setup, EFT (Electronic Funds Transfer) enrollment, and provider registration with Availity, NaviNet, CAQH, UHC-Link, Optum, etc.
• Denial Management & Appeals: Identify denied claims, investigate reasons, and submit disputes when necessary.

MUST BE ABLE TO PROVIDE REFERENCES