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Managed Care Billing Specialist
4 months ago
**Managed Care Billing Specialist**
**Salary Grade: 21**
**Full Time salary range: $72,128 - $82,241**
**Function and Scope**
The Strategic Finance & Managed Care Group, Bureau of Managed Care Finance and Data Analytics is recruiting to fill a Managed Care Billing Specialist position. This Division monitors the managed care service-delivery and payment system for mental health, evaluates health plans' performance, and calculates and implements the rate for the services delivered by OMH licensed providers in both Fee-for-service and Managed Care systems. The incumbent of this position will work among a multidisciplinary team in the Managed Care Finance and Data Analytics Bureau, which is responsible for numerous data, fiscal, and billing related activities within the Medicaid managed care payer system.
**Responsibilities**
Job duties and responsibilities include but are not limited to the following:
- Assist with internal and external processes related to provider payment complaints and billing guidance related to Medicaid managed care.
- Serve as a liaison and collaborate with other NYS human service agencies including OASAS, DOH, OPWDD, and OCFS as well as other Divisions within OMH on managed care related billing issues.
- Assist in the development of communications originating from the Finance and Data Analytics Bureau, including guidance and policies issued to providers and MCOs related to managed care billing and claims adjudication.
- Assist in monitoring and reviewing State and Federal healthcare and Medicaid statutes, regulations, and policies to identify pertinent billing and finance related issues and assess their programmatic and financial impact on NYS behavioral health managed care.
- Represent the Finance and Data Analytics Bureau in routine, focused, operational, and targeted MCO surveys.
- Communicate and assist in developing briefings for key executive leadership on systemic MCO issues related to claims denial issues, provider viability, or member access issues.
- Collaborate with state agency partners to identify and investigate issues and prescribe solutions as needed.
- Attend and present at multiple stakeholder Managed Care forums for behavioral health managed care.
- Other duties as assigned.
**Minimum** Qualifications**
- Bachelor's degree from an accredited college AND at least 1 year of experience working in State agencies that oversee government-funded insurance (i.e., Medicaid and Medicare) or commercial insurance.
**Preferred Qualifications**
- At least 1 year of experience submitting health care claims to insurance plans in an automated environment.
- Medical billing specialist certification or medical billing experience
- At least 1 year of experience with reimbursement methodologies (e.g., Diagnostic Related Groups (DRG), Ambulatory Payment Classification (APC), and Ambulatory Patient Groups (APG)).
**Working Location**:44 Holland Avenue, Albany, NY
The Mission of the Research Foundation for Mental Hygiene, Inc. (RFMH) is to promote the mental health of all New Yorkers, with a focus on providing hope and supporting recovery for adults with serious mental illness and children with serious emotional disturbances. Applicants with lived mental health experience are encouraged to apply. RFMH is deeply committed to supporting underserved individuals, organizations, and communities. To this end, RFMH is focused on implementing activities and initiatives to reduce disparities in access, quality, and treatment outcomes for underserved populations. A critical component of these efforts is ensuring that RFMH is a diverse and inclusive workplace where all employees' unique attributes and skills are valued and utilized to support the mission of the Agency. RFMH is an equal opportunity/affirmative action employer.
The Research Foundation is a private not-for-profit corporation and is not an agency or instrumentality of the State of New York. Employees of the Research Foundation are not state employees, do not participate in any state retirement system, and do not receive state fringe benefits. Excellent Benefits Package. Employer/Minority/Women/Disabled/Veteran Employer. VEVRAA 41 CFR 60-300.5(a) compliant.
