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BILLING SPECIALIST

POUGHKEEPSIE, NY

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Category:

MEDICAL BILLING

Status:

FULL TIME

Type of Business

HUMAN SERVICES

Job Qualifications:

The Billing Specialist is responsible for all aspects of claim payment and follow-up including payment application, denial management, appeals, re-billing and waterfall billing. This position will require extensive communication with payers and between internal departments. Reports to the Associate Director of Revenue Cycle Management.

Job Description:

The Billing Specialist is responsible for all aspects of claim payment and follow-up including payment application, denial management, appeals, re-billing and waterfall billing. This position will require extensive communication with payers and between internal departments. Reports to the Associate Director of Revenue Cycle Management.

Responsibilities:

  • Review, post and fully reconcile all 3rd Patty and client payments through 835 file upload and manual entry including all necessary accounting functions Re-bill claims as needed and bill all payers in waterfall process
  • Manage all 3rd party denials, identify trends, reporting and communicating with appropriate staff
  • Complete all levels of appeals adhering to the payer specific appeal requirements.
  • Position requires extensive communication with 3rd party payers, clients and staff.
  • Respond to all 3rd party requests for information including refunds, medical records, provider and client data
  • Examines claims, charges and payments for compliance with agency, 3rd party and regulatory requirements
  • Provide regular periodic reports and updates on denials, unpaid accounts, payments and any issues impacting revenue
  • Perform general billing duties including but not limited to: reconciling billed services; remittance processing, insurance denial follow up, collections and communicate billing and insurance issues to appropriate staff
  • Effectively communicate with the vulnerable populations served by our agency as needed
  • Maintain current and accurate account information in the client and agency systems Maintain current knowledge of all job specific requirements and related regulations

Qualifications:

Education: High School diploma or GED, CPC License preferred                                                                   

Experience:

  • Minimum three (3) years' experience required in a medical-related environment and/or aptitude to understand medical billing and medical claim denial resolution based on prior work history.
  • Previous Medicaid billing/EMEDNY preferred.
  • Experience working with a diverse population preferred.
  • Typing, data entry, general clerical and strong mathematical skills required.

Competencies:

  • Knowledge of Medical Terminology, CPT, HCPCS and ICD-IO coding.
  • Knowledge of NetSmart/ RevConnect and OMH reporting is a plus
  • Excellent documentation, verbal and written communication skills
  • Knowledge of Microsoft Office; especially EXCEL
  • Attention to detail
  • General math skills
  • Knowledge of procedures and revenue cycle flow in a healthcare organization. Willingness to travel for agency business
  • Ability to learn and work within agency procedures and guidelines
  • Ability to exercise sound judgment in tracking sources of errors and in using established guidelines to determine the necessary corrective action

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BILLING SPECIALIST
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