Billing Specialist

Job Summary:

The Billing Specialist performs daily activities related to the submission of accurate and timely billings to (Medicaid, NYS Paid Invoices and Self Pay Invoices) This position supports Revenue Cycle and Departmental goals and objectives by tracking timely billing of claims, monitoring receipt of payments and by optimizing the accuracy of billable services.

Essential Duties and Responsibilities:

• Processes Claims correction/RTP/ Rebilling and monitoring for outstanding claim status.
• Works collaboratively and cohesively with CCO staff to ensure accurate and timely billing.
• Assists in reconciling and processing claims in error status.
• Provides accurate communication in verbal, non-verbal and written form. Listens effectively, and consistently communicates appropriately with members and staff and responds to request assistance promptly.
• Communicates effectively with supervisor and team members including but not limited to changes in operations. Reports to supervisor regularly on the status of ongoing projects.
• Maintains knowledge of applicable rules, regulations, polices, and guidelines that impact account collection.
• Collects data and produces reports as required.
• Reviews notes to ensure all documentation is accurate, complete and meets OPWDD standards.
• Reconciles Private Pay and State Paid Remits
• Write-Off balances of approved claims
• Reviews Pended Claims report to capture potential billing issues.
• Reviews HCBS Monthly Report for billable services
• Reviews Billing Codes, Tier Assignment & Eligibility for New Enrollees and CCO Transfers
• Completes monthly spend down billing.
• Reviews claims on hold for potential voids and/or end of hold dates.
• Processes voided claims as requested by Compliance.
• Checks members with no encounter for billable services.
• Assists in the monitoring and implementation of Billing policies and procedures.
• Assists the Director of Billing in training and education for new staff.
• Assists the Director of Billing and other members of the Finance/ Billing team with special projects as directed.
• Maintains confidentiality.
• Performs other duties, as assigned.
• Must possess a valid Drivers License from New York, or a contiguous state (i.e., Connecticut, New Jersey, Pennsylvania, and Vermont) OR must have the ability to take ample public transportation to attend meetings in person in the community and in the office as needed.

Education and Experience:

• A Bachelors degree is required.
• A minimum of two years of experience related to health care in-patient billing is required.
• Knowledge and familiarity with Medicaid billing experience or other related expertise is preferred.
• Requires daily contact with staff, members and families, and other outside providers and agencies with cross organization communication on a regular basis.
• Excellent math skills required.
• Proficiency in use of PC and Microsoft Office Suite use.
• Capable of learning billing system and other pertinent database and software programs
• Requires the ability to manage multiple priorities.
• The ability to plan, organize and schedule own work to meet required deadlines.
• Knowledge of Billing functions/operations, HIPAA Privacy & Security Rules and other applicable government regulations, and professional guidelines. Excellent attention to detail and organizational skills are required.
• Absolute sense of integrity and personal commitment to serving people with I/DD and their families.
• Excellent interpersonal, communication organization and demonstrated ability to manage multiple tasks simultaneously.
• Ability to work autonomously.
• Demonstrate professionalism, respect, and ability to work in a team environment.