Seeking a well-seasoned healthcare and/or social services billing professional with 3+ years of experience, preferably with CPT, HCPCS, and ICD coding and procedure certification/validation. Must have exceptional communication skills as the position requires daily interaction with several departments from within and external to the organization. Knowledge of medical terminology and the revenue cycle process are integral to overall success in the position. Must maintain accuracy, confidentiality, and timeliness of all information as mandated by the NYS OPWDD, The Center for Discovery, and other commercial/ governmental payers.
Essential Functions include daily data processing for the following services:
Developmental Disabilities Programs
o Adult and Children Day-Hab Program(s) (Monthly)o IRA (Monthly)o MSC (Monthly)o Submit claims to clearinghouse (Medicaid and Medicaid Managed Care), fix rejections as neededo Upload remits into software and save files in the financial drive weekly, by programo Work on denied claim(s) and rebill when necessaryo Together with medical billing manger, provide billing report(s) to senior staff and enter data into Financial Edgeo Maintain issue tracker between program and finance to ensure all corrections are made in a timely fashiono Other duties as neededMental Health- Article 31 Clinico Use coded data to produce and submit claims to Medicaid and insurance companieso Working directly with the Medicaid, insurance companies, healthcare provider(s), and patient(s) to get claim(s) processed and paid as appropriate.o Produce source material to agency so they can review and, if appropriate, appeal unpaid claim(s)o Manage A/R, follow up on all denied, rejected and pended claims and work on aging report weekly.o Post manual remits into third party software (if applicable)o Reconcile copay and deposit o Super User for third part billing softwareo Together with the medical billing manager, provide billing report to senior staff and enter into Financial Edgeo Other duties as neededFoster Care- Mental Health Clinico Run report in third party billing software for monthly billing censuso Print out progress notes sent by clinic staff to attach to the billing sheet in Excelo Scan completed billing and progress notes into the “Y” driveo Manage A/R and contact FCA agencies with outstanding claimso Together with the medical billing manager, provide billing report to senior staff and enter into Financial Edgeo Other duties as neededHealth Homeso Run monthly census to review with program and ensure all claims have been captured for the montho Run remit reports to validate revenue receivedo Together with the medical billing manager, provide billing report to senior staff and enter into Financial Edgeo Other duties as needed
High School Diploma Required; Associate’s/Bachelor’s Degree Preferred3+ years’ experience in a medical billing role; preferred experience in OPWDD, Article 31, and/or human servicesFamiliarity with Medicaid and insurance web portals and knowledge with the life cycle of claim(s)Intermediate to advanced knowledge with MS office products, (V-lookup, Pivot tables, Advanced formulas, Linked spread sheets, etc.)Experience with E-MEDNY and E-PACESFamiliarization with EHR and Charge-Master