Medical Billing Specialist

Job Description

Job Description

Description :

Job Title : Medical Billing Specialist

Salary : $25-$30 per hour

Supervisor : Director of Behavioral Health Services Department : Behavioral Health Services

FLSA Status : Full Time – Exempt

==========================================================================================

GENERAL DESCRIPTION :

The Medical Billing Specialist coordinates with the Authorization & Payroll Specialist and Director of Behavioral Health Services to ensure all CFTSS and HCBS services are billed and adjudicated in accordance with the New York State Department of Health (NYSDOH) and federal regulations. The Medical Billing Specialist can work independently and efficiently under pressure. They conduct follow-up correspondence to resolve open and denied claims via email or on the phone. The Medical Billing Specialist may act as a liaison between MDPYFS and the MMCPs (Medicaid Managed Care Plans) that insure the clients on the Behavioral Health Services Department’s roster. They keep records organized and can complete tasks quickly and efficiently, in order of highest priority.

MAJOR DUTIES AND RESPONSIBILITIES :

• Verify clients’ eligibility weekly.
• Maintain updated billing profiles for all clients in the clearinghouse database.
• Report service provision overutilization including but not limited to fraud, waste, and abuse.
• Process, correct, and rebill claims for adjudication using ICD-10 codes if necessary.
• Audit Explanations of Payments (EOP) from MMCPs.
• Reconcile incoming payments.
• Resolve denied and underpaid claims via the dispute, appeal, or grievance process.
• Liaise between NYS Medicaid programs and MMCPs.
• Ensure ongoing communication with the Director of Behavioral Health Services regarding the escalation of service-impacting issues.
• Develop and implement process improvement initiatives.
• Perform ongoing independent research related to changes in industry standards.
• Attend quarterly Department meetings to provide necessary feedback.
• Perform all other duties as assigned.

QUALIFICATIONS : EDUCATION :

EXPERIENCE :

REQUIRED SKILLS AND ABILITIES :

BACKGROUND VERIFICATION and CLEARANCE :

Section 424-A of the New York Social Services Law requires an authorized agency to inquire whether a candidate for employment with child-caring responsibilities has been the subject of a child abuse and maltreatment report.

REQUIRED ACTIVE CERTIFICATIONS :

EXPECTED HOURS OF WORK :

PHYSICAL REQUIREMENT :

Requirements : QUALIFICATIONS :

EDUCATION :

Bachelor’s Degree

EXPERIENCE :

At least two (2) years of administrative or supervisory experience

At least two (2) years of medical billing experience

Familiarity with billing and coding terminology

REQUIRED SKILLS AND ABILITIES :

Highly organized and detail-oriented

Business Acumen

Effective oral and written communication skills

Consultation

Relationship management

Time management

Data input

Ability to communicate effectively with stakeholders

Understanding and incorporation of the Lasallian Culture of Care as a work philosophy

Ability to work varying hours as needed

Proficient computer skills (Microsoft Word & Excel)

Excellent problem-solving capability and ability to meet multiple deadlines under pressure

ACTIVE CERTIFICATIONS :

Mandated Reporter

Lasallian Culture of Care (LCC)

Required training as delineated by the oversight agency and or MDPYFS

SUPERVISORY RESPONSIBILITY :

This position may serve as a consultant and mentor in the agency.

EXPECTED HOURS OF WORK :

The number of days will vary based on the agreed work schedule. The hours of work are up to forty (40) hours per week. This position may require long hours and occasional weekend work as the job demands.

BACKGROUND VERIFICATION and CLEARANCE :

Section 424-A of the New York Social Services Law requires an authorized agency to inquire whether a candidate for employment with child-caring responsibilities has been the subject of a child abuse and maltreatment report.

Credential Verification

Medical and Physical clearance, which includes TB screening

State Central Registry (SCR) Clearance

Staff Exclusion List (SEL)

Justice Center Background Check

Required training as delineated by the oversight agency and or MDPYFS

Reference Verification

PHYSICAL REQUIREMENT :

Lifting requirement of 50 Lbs.

Ability to meet physical requirements of the position when performing the following : standing, walking, sitting, bending, stooping, squatting, kneeling, and climbing.