Revenue Cycle & Credentialing Coordinator
Department: Finance / Revenue Cycle
Reports To: Chief Financial Officer
Location: Charleston, WV
Position Summary
The Revenue Cycle & Credentialing Coordinator is responsible for supporting the organization’s revenue cycle operations through billing oversight, cash receipts processing, provider credentialing, payer enrollment, contract administration, and reimbursement support. This position serves as a key liaison between clinical operations, payers, and finance to ensure timely reimbursement, regulatory compliance, and accurate provider enrollment across all service lines.
Essential Duties and Responsibilities
Revenue Cycle Operations
- Assist with oversight of palliative care billing processes.
- Monitor claims submission, payment posting, denials, and accounts receivable follow-up.
- Research and resolve billing discrepancies, rejected claims, and payer issues.
- Coordinate with clinical and operational departments to obtain documentation necessary for claim resolution.
- Track and report revenue cycle performance metrics, including aging, denial trends, and reimbursement concerns.
- Support month-end revenue and receivable reconciliation activities.
Cash Receipts & Payment Processing
- Process and reconcile daily cash receipts and electronic remittance activity.
- Verify accuracy of payments received from Medicare, Medicaid, managed care, and commercial payers.
- Assist with preparation of deposit documentation and cash reconciliation reports.
- Investigate unapplied cash and payment variances.
- Maintain supporting documentation for audit and compliance purposes.
Credentialing & Provider Enrollment
- Manage provider credentialing and recredentialing activities.
- Coordinate payer enrollments, updates, and revalidations for physicians, nurse practitioners, and other providers.
- Maintain credentialing files, licenses, certifications, malpractice coverage, and supporting documentation.
- Monitor enrollment deadlines and renewal requirements to avoid interruptions in reimbursement.
- Serve as primary contact with Medicare, Medicaid, and commercial insurance credentialing representatives.
Contract Management
- Maintain payer contract database and supporting documentation.
- Track contract renewals, amendments, and reimbursement changes.
- Assist leadership with reviewing payer reimbursement terms and contract compliance.
- Coordinate communication regarding contract implementation and updates.
Reporting & Compliance
- Maintain accurate records and documentation supporting billing and credentialing activities.
- Prepare reports related to credentialing status, payer enrollment, reimbursement issues, and revenue cycle performance.
- Support internal and external audits.
- Ensure compliance with Medicare, Medicaid, HIPAA, payer, and organizational requirements.
Qualifications
Education
- Associate degree in Accounting, Business Administration, Healthcare Administration, or related field required.
- Bachelor’s degree preferred.
Experience
- Minimum of three years of healthcare billing, revenue cycle, credentialing, or related healthcare finance experience.
- Hospice, home health, palliative care, or post-acute care experience strongly preferred.
- Experience with Medicare and Medicaid billing processes required.
- Experience with provider credentialing and payer enrollment preferred.
Knowledge, Skills, and Abilities
- Knowledge of healthcare reimbursement methodologies and payer requirements.
- Understanding of provider credentialing and enrollment processes.
- Strong attention to detail and organizational skills.
- Ability to analyze data and identify billing or reimbursement issues.
- Proficiency in Microsoft Excel and healthcare billing systems.
- Strong written and verbal communication skills.
- Ability to handle confidential information with discretion.
We also offer, competitive benefits, 5% employer 403B retirement match, vacation, sick, holiday and personal leave. HospiceCare also participates in the WV Tri-Share Childcare program.
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