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Healthcare Billing Specialist

2 months ago

Syracuse, New York, United States Kelberman Full time


The Healthcare Billing Specialist position is accountable for managing comprehensive insurance contracting and credentialing procedures, in addition to processing billing and payments on claims for clinic and program services with precision and timeliness; monitoring and following up as required.

Compensation: $20.00 per hour

Key Responsibilities:
  • Maintain an up-to-date understanding of enrollment and billing policies, guidelines, and updates for OPWDD-regulated programs and services, as well as third-party insurers.
  • Engage with third-party insurers to establish, maintain, and amend contracts for the organization and/or individual providers.
  • Negotiate reimbursement rates with third-party insurers.
  • Complete single-case agreements with third-party payments as necessary.
  • Oversee the accurate collection of insurance prior-authorizations.
  • Ensure precise client insurance plan coverage and payment responsibilities, including timely notifications to clients.
  • Conduct payor credentialing functions (i.e., enrollment in Medicaid, Medicare, and third-party insurers) for licensed providers.
  • Collect and manage the renewal/recertification of provider licenses/certifications.
  • Administer providers' malpractice/liability insurance coverage through the organization.
  • Coordinate with providers to complete/update CAQH profiles and credentialing documentation efficiently.
  • Maintain Kelberman ETIN certifications for relevant programs and individual providers.
  • Possess a working knowledge of CPT and ICD-9 coding principles, governmental and state regulations, protocols, and third-party requirements regarding coding and billing documentation.
  • Accurately submit and oversee the submission of billing claims to Medicaid, Medicare, and third-party insurers.
  • Responsible for investigating unpaid claims to identify issues related to non-payment (coverage limitations, billing, coding, or demographic errors).
  • Contact Medicaid, Medicare, third-party payers, and clients to take appropriate corrective actions to secure payment on those claims.
  • Perform additional duties as assigned.
Qualifications:
  • Medical billing/coding certification and 1-2 years of experience in healthcare billing or a comparable combination required.
  • Associate's degree and 3 years of relevant experience preferred.
  • Knowledge of enrollment and billing for OPWDD waiver services, Article 16 clinics, and applied behavior analysis services, including collaboration with third-party insurers.
  • Experience with PECOS and eMedNY platforms.
  • Familiarity with Medicare, Medicaid, various other federal and state payors/programs, commercial insurance enrollment and reimbursement procedures, and knowledge of ICD9, CPT, HCPCS is highly desirable.
Work Environment and Physical Demands:
  • The employee frequently is required to stand, walk, and sit. Must be able to remain in a stationary position for extended periods.
  • Must be able to bend, twist, and reach with fingers and arms.
  • Must have the ability to lift up to 25 pounds.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position without compromising workflow and efficiency.

Supervised by: Chief Financial Officer

Supervisory Responsibilities: This position has no supervisory responsibilities.

The above job description is intended to describe the general nature and level of work being performed; it is not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required for the position. This job description may be modified at any time and does not constitute a contract or agreement.

Position Requirements

Position
Healthcare Billing Specialist

Exempt/Non-Exempt
Non-Exempt

About the Organization
The Kelberman Center is a leading provider of autism services for children, adults, and families in the Mohawk Valley and Central New York.

We provide comprehensive programming and services for individuals throughout all phases of life, from early childhood through adulthood, including: Home and Community Based, Educational, Clinical, Residential, and Recreation and Camp. Our goal is to meet individuals and families where they are in life and to support them every step of the way on their journeys navigating autism. The expert staff at The Kelberman Center empower the individuals we support with specialized, unique programs, resources, support, and wrap-around services, creating a fulfilling, life-enriching experience for individuals and families.

We believe in the power of individuals, families, and communities working together to maximize our collective potential.

EOE Statement
We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.

This position is currently accepting applications.