Billing and Insurance Credentialing Specialist in Arizona at ALIUM HEALTH

Position Summary

The Billing & Insurance Credentialing Specialist is responsible for daily billing operations, claims follow-up, payment reconciliation, insurance eligibility verification, and provider credentialing and enrollment for Primary Care and Behavioral Health. This position ensures accurate billing, timely reimbursement, and maintenance of provider participation with applicable insurance plans.

Essential Job Functions

Medical Billing & Revenue Cycle

• Work daily billing queues in AthenaNet and other applicable systems, including Hold, Eligibility, Missing Slips, Interface Errors, and TOS Money.
• Follow up on unpaid claims, denials, rejections, and outstanding accounts receivable.
• Review and correct billing discrepancies and resubmit claims as needed.
• Complete assigned weekly and monthly reports, including refunds, unapplied credits, payment mismatches, A/R aging, and insurance denials.
• Reconcile daily TOS payments and submit cash, checks, and reconciliation reports to the Office Manager.
• Monitor deposits, payment posting, and outstanding financial discrepancies.

Insurance Credentialing & Enrollment

• Coordinate credentialing and insurance enrollment for Primary Care and Behavioral Health providers with AHCCCS plans, Medicare, and commercial insurance payers.
• Complete and submit provider and organizational enrollment applications and maintain required documentation, including NPIs, TINs, licenses, CAQH profiles, and W-9 forms.
• Track applications, follow up with payers, and maintain accurate records of submission dates, approvals, effective dates, and outstanding requirements.
• Manage recredentialing, license renewals, CAQH reattestations, and other enrollment deadlines.
• Verify provider enrollment, group affiliations, locations, and effective dates to support accurate claim submission.
• Assist with payer contracts, provider onboarding, demographic updates, and enrollment issues.
• Communicate delays, missing documentation, and potential billing or reimbursement risks to management.

Eligibility, Administration & Compliance

• Verify AHCCCS and commercial insurance eligibility and benefits using approved systems and payer resources, documenting verification results and escalating discrepancies as needed.
• Respond to work-related emails and requests within one business day when practicable, prioritizing urgent matters and following established communication and coverage procedures.
• Maintain complete, accurate, current, and appropriately secured billing, credentialing, enrollment, and payer contract records in accordance with organizational policies and applicable retention requirements.
• Follow applicable federal and state laws, payer requirements, organizational compliance policies, and established billing and documentation procedures.
• Protect PHI and other confidential information in accordance with applicable HIPAA requirements and organizational privacy and security policies.
• Promptly report suspected privacy or security incidents, inaccurate claims, potential compliance violations, and unresolved financial discrepancies through established reporting channels.
• Participate in required compliance training, audits, and related corrective-action activities as assigned.
• Provide professional service to patients, providers, payers, and colleagues while maintaining appropriate confidentiality.
• Perform other related duties consistent with the position and organizational needs.

Performance Expectations

• Complete assigned billing queues, claim follow-up, and reconciliations within established deadlines and quality standards.
• Maintain accurate documentation of claim status, denials, corrections, payment discrepancies, and follow-up activities.
• Track outstanding claims and accounts receivable and escalate items approaching payer filing deadlines or requiring management intervention.
• Maintain current credentialing and enrollment trackers, including submission dates, approval status, effective dates, expirations, and outstanding requirements.
• Review pending applications and upcoming renewals at established intervals and initiate follow-up early enough to address foreseeable delays.
• Provide management with monthly status reports on credentialing, enrollment, renewal deadlines, and significant reimbursement risks.
• Promptly communicate unresolved issues, potential enrollment gaps, and material billing or compliance concerns.
• Meet established accuracy, productivity, timeliness, documentation, and confidentiality standards.

Qualifications

• High school diploma or equivalent required.
• Minimum of one year of medical billing or healthcare revenue cycle experience required.
• Medical Billing Certification preferred.
• Experience with AHCCCS and commercial insurance verification required.
• Provider credentialing and payer enrollment experience preferred.
• EHR experience required; NextGen preferred. AthenaNet experience beneficial.
• Strong organizational, communication, customer service, and problem-solving skills.
• Ability to manage multiple priorities, meet deadlines, maintain confidentiality, and work independently.

Additional Duties: This job description is not all-inclusive. Other related duties may be assigned based on organizational needs.

Working Conditions

Work is performed remotely, with the potential need to come into the clinic. The employee must be able to use a computer and telephone for extended periods, communicate effectively with members and agency representatives, manage confidential records, and perform the essential functions of the position with or without reasonable accommodation.

Equal Employment Opportunity

Alium Health provides equal employment opportunities to qualified applicants and employees and does not discriminate on the basis of any status protected by applicable law. Reasonable accommodations may be available to qualified individuals with disabilities.