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Billing Specialist

3 months ago

Staten Island, United States Seamen's Society for Children and Families Full time

**Job Summary**:
The Billing Specialist will identify trends that impact billing, such as held claims, rejected claims, denials, and other issues that prevent timely claim adjudication, and communicate these trends to the Chief Financial Officer and the Controller.

Program Services are delivered under a Medicaid Managed Care model (CFTSS/OLHRS) and a Health Homes Care Management model (HHCM).

**Duties and Responsibilities**
- Ensures timely and accurate completion of weekly billing claims.
- Consistent communication with Millen Pro billing system and/or individual MCOs to address and resolve any outstanding billing matters. This includes but is not limited to, denials, claim adjustments, eligibility, receivables, etc.
- Obtain and submit all documentation required for credentialing/recredentialing with MCO partners.
- Work closely with both programs to monitor eligibility, address any concerns about billing delays, and ensure prompt claim resolution to minimize denials.
- Create and maintain a Revenue by Clinician dashboard to be shared with the program and leadership monthly
- Actively participate in all program meetings concerning CFTSS/OLHRS, HHCM, Quality Assurance/Improvement (QA/QI), and Compliance matters.
- Run HHCM reports in FCM on time to capture the claims data as needed for reporting.
- Manages all follow-up activities to ensure all claims are fully collected with no outstanding balances remaining.
- Ensures all billing operations comply with Federal and State payer regulations, guidelines, and requirements.
- Additional duties as assigned or as needed to support departmental or organizational goals.

**Skills/Knowledge/Abilities**:

- Possess comprehensive knowledge of ICD-10 coding and medical coding relevant to CFTSS/OLHRS.
- Strong working knowledge of Medicaid, Medicare, and Managed Care fee-for-service (FFS) billing and reimbursement and denial management
- Knowledge of Electronic File transmittals/remits with Medicaid/Medicare EDI departments
- Strong computer skills
- Strong leadership and interpersonal skills
- Excellent verbal and written communication skills
- Ability to multi-task, prioritize competing demands, and thrive in a fast-paced environment
- Ability to make independent decisions and accurate judgments for A/R, billing, and office duties
- Experience with medical electronic health record systems a plus
- Experience with Health Homes Management and Foothold system a plus

**Qualifications/Requirements**:

- Associate degree or Medical Coding Certificate required
- 3-6 years of Medical Billing/Collections experience required
- Remote but in office as needed up to 2 or 3 days per month
- 25 hours per week initially
- Performs other duties/responsibilities as assigned within the scope of the position

**Additional Information**:
Seamen’s Society is committed to providing an inclusive and welcoming environment for all members of our staff, participants, volunteers, subcontractors, and vendors. We respect diversity and, accordingly, are an equal opportunity employer that does not discriminate on the basis of race, color, creed, religion, national origin, alienage, citizenship status, age, disability, sex, gender, gender identity or expression, sexual orientation, marital status, partnership status, veteran status, genetic information, or any other status protected by applicable federal, state, or local law.

**Job Type**: Part-time

Pay: $35.00 - $45.00 per hour

Expected hours: 25 per week

Work setting:

- Hybrid work
- Office

**Education**:

- Associate (preferred)

**Experience**:

- Medicaid, Medicare Billing/Collection and reimbursement: 3 years (required)
- Electronic transmittal/remits with Medicaid/Medicare EDI: 3 years (required)
- Managed Care fee-for service (FFS) billing and reimbursement: 3 years (required)
- Medical electronic health record system: 3 years (preferred)
- Health Homes Management and Foothold systems: 2 years (preferred)

License/Certification:

- Medical Coding Certification - ICD-10 (required)

Work Location: Hybrid remote in Staten Island, NY 10301