Job Description

Key/Essential Functions & Responsibilities

• Maintains responsibility for all day-to-day processing, maintenance and tracking of billable services/ receivables for assigned region(s), regularly collaborating with applicable program leadership, financial analyst and/or other finance staff to support complete and accurate billing of services with state and/or federal agencies.
• Serves as primary point of contact for billing inquiries for assigned state(s) from program leadership and other stakeholders, including regulatory agencies; escalates concerns and requests to supervisor for assistance and handling, when needed.
• Runs, reviews and shares monthly billing reports from electronic billing system to ensure that all services are reviewed and approved for billing by appropriate program leadership within established timelines to support compliance with all applicable deadlines.
• Conducts regular follow-ups with program leadership to secure confirmations and ensure timely and complete processing of billing and maximize reimbursement for services.
• Submits billing on a monthly basis in applicable online and/or electronic systems or portals (e.g. Regional Centers, NJ DDD, etc.) and resubmits revised or corrected claims upon receipt and/or in accordance with applicable agency requirements.
• Reconciles billing reports and entries within electronic portals by flagging individuals and/or specific services without posted payments on a monthly basis and follows up until corrections are made and payments post.
• Proactively reviews applicable electronic systems and portals on a regular basis to ensure that all services are accurately captured and information is current, identifying and escalating any issues that might cause delays in billing; makes notifications and/or coordinates updates, follows up on retroactive coverage and reconciles any discrepancies.
• Enters and maintains all billable services for assigned state(s) in electronic billing system, confirming accuracy of rates in system prior to submitting billing and works with supervisor to resolve any discrepancies or concerns.
• Tracks receipt of payments in applicable systems, retrieving documents and files and posting all payments into the electronic billing system.
• Receives and redirects inquiries from program staff regarding the electronic medical record including staff access or workflow questions, troubleshooting and overall support for handling by appropriate parties and/or assists, when appropriate.
• Provides regular updates to other finance department staff and escalates billing, state or other agency concerns or issues and inefficiencies to financial analyst and supervisor for handling.
• Assists with maintaining the Accounts Receivable (A/R) aging for programs, where applicable, which includes working with the programs to reconcile any outstanding accounts receivable, coordinating with entitlements team and/or conducting follow-ups for information needed to obtain authorizations for services to support billing.
• Provides support to other members of finance department, including financial analyst and/or supervisor based on assigned state for billing-related matters, including preparing and distributing reports or statements, collecting information and ensuring billing and payment related information is updated in all applicable systems.
• Assists Director of Revenue Management with gathering data and documents for requests by Quality and Compliance department and/or for any other program or financial audit or review.
• Performs a variety of clerical, administrative and financial tasks to support revenue management department as requested including, but not limited to filing, copying, scanning and/or data entry; creating memos, lists, spreadsheets or other documents; and/or making notifications or inquires by email or phone.
• May represent the revenue management department in regional or program meetings for assigned state(s), communicating with programs to collect information needed to support appropriate processing of billing and to learn about changes that impact billing (funding sources, policies, practices, platforms, etc.), providing updates to supervisor and applicable stakeholders.
• Complies with all Federal, State, Local and other relevant regulatory agency requirements, including the Health Insurance Portability and Accountability Act (HIPAA) and ensures cooperation with appropriate entities in any inspection, inquiry or investigation.
• Performs all other duties, as assigned.

Minimum Qualification Requirements including education, experience, licensure/certification, etc. and essential physical capabilities (e.g. lifting, assisting lifting, standing, etc.)

• Bachelor’s degree in finance, business or related discipline; and
• Two (2) years of experience working with the I/DD population or related experience in human or social services including assisting people in applying for services and/or exposure to benefits or entitlements; or
• Two (2) years of experience performing administrative support duties relating to finance or healthcare-related billing including data entry, tracking data, accounts receivable, bookkeeping or similar duties; or
• Satisfactory equivalent combination of education, experience and/or training.
• Ability to report on-site to our Manhattan office at least three (3) days per week in accordance with the Agency’s Return to Office Policy.
• Ability to work a flexible schedule, including evenings if needed on an occasional basis, to attend related meetings or meet deadlines.
• Familiarity with benefits and entitlements in the healthcare and/or I/DD field including Medicaid, Medicare and applicable regulatory agencies.
• Strong written and oral communication skills, including the ability to effectively obtain and communicate information with staff and stakeholders at varying levels.
• Detail oriented and highly organized, with good time management and follow-up skills, including the ability to effectively track and accurately compile data.
• Strong quantitative and problem-solving skills, including the ability to quickly identify discrepancies and determine resolutions needed to support successful billing.
• Ability to prioritize multiple tasks to meet billing submission deadlines.
• Ability to work autonomously and work well in groups, including building relationships and working collaboratively with program leadership and stakeholders.
• Proficiency with computers and ability to quickly learn electronic systems including Digital Agency (DA), electronic health record, Workday and state-specific systems or portals and advanced knowledge of Microsoft Office applications, specifically Word and formulas, v-look ups and pivot tables in Excel.

Preferred Qualification Requirements ( desired requirements beyond MQRs above)

• Previous experience with medical billing and systems, specifically billing for services received by individuals with I/DD in assigned state of operations (NY, NJ or CA)

This job is Monday-Friday, 9am-5pm

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