Billing and Claims Specialist

At CMCS (Cardinal McCloskey Community Services), our mission is to protect, empower and promote independence for at-risk children and families and those with developmental disabilities through quality community based services.

Responsibilities:

• Prepare, review, and submit claims for Article 31 clinic services, Article 29-I services, CFTSS programs, and OPWDD-funded services, including IRA, Day Habilitation, Supported Employment, and Community Habilitation.
• Prepare and submit basic contract and program invoices in accordance with funding source requirements and established deadlines.
• Verify patient eligibility, insurance coverage, authorizations, referrals, service documentation, and demographic information prior to claim submission.
• Ensure claims and invoices are submitted in compliance with Medicaid, Medicaid Managed Care, Medicare, commercial insurance, OPWDD, OMH, OCFS, DOH, and contractual requirements.
• Review billing edits, claim rejections, and payer denials and take corrective action to ensure timely reimbursement.
• Process claim corrections, adjustments, voids, and resubmissions as necessary.
• Monitor and analyze accounts receivable and aging reports and conduct timely follow-up on unpaid, denied, or underpaid claims and invoices.
• Communicate with payers, funding sources, and program staff regarding claim status, authorization issues, reimbursement discrepancies, and outstanding receivables.
• Maintain detailed documentation of billing, collection, and follow-up activities.
• Accurately post payments, adjustments, refunds, and remittances and reconcile billing records as required.
• Maintain EHR and billing system information, including payers, plans, rates, procedure codes, and billing parameters.
• Identify billing, reimbursement, and revenue trends and communicate findings to management

Requirements:

• Bachelor's Degree preferred.
• Experience with Electronic Health Record (EHR) and billing systems.
• Thorough understanding of medical claims billing, accounts receivable management, and reimbursement processes.
• Experience billing OMH-licensed Article 31 clinics, Article 29-I services, CFTSS programs, and/or OPWDD-funded services, including IRA, Day Habilitation, Supported Employment, and Community Habilitation.
• Experience preparing and submitting NYC/NYS contract or grant-funded invoices preferred.
• Knowledge of Medicaid, Medicaid Managed Care, Medicare, commercial insurance, and government-funded billing requirements.

CMCS offers:

• Medical, Dental & Vision Insurance
• 403(b) Retirement Plan
• Generous Paid Time Off
• Flexible Work Schedules

If you're ready to make a meaningful impact and be part of a compassionate, dedicated team, apply today and start your journey with CMCS!