Senior Billing Specialist

Location: Middletown, NY Pay Rate: $26.44 per hour Hours: Monday-Friday 8:00AM-4:30PM (40hrs)   OVERVIEW OF PRIMARY RESPONSIBILITES:   The Senior Billing Specialist is a key position in the financial management of the company. The Senior Billing Specialist supports all billing and revenue management throughout the revenue cycle.  This individual manages the electronic claims process, including accurate and timely claim batch creation, submission, and uploading of claims with providers and insurance companies, including but not limited to daily procedure review, self-pay and co-payment processing, ensuring payments related to participant services from all sources are recorded and reconciled timely in order to maximize revenues.  Additionally, the Senior Billing Specialist will assist Finance in maintaining the financial data required for revenue management report generation, and assist with credentialing management and regulatory audits. PRIMARY FUNCTIONS:   Promote revenue cycle improvements throughout the organization, including working with appropriate programs, front desk staff, remit, denial management and insurance verifications areas to aid in the resolution of identified revenue cycle billing issues Handling billing cycle review procedures for pre-processing (scrubbing) of weekly claims processing Analyze, billing and processing program claims for accuracy and completeness; submit claims to proper insurance entities and follow up on any issues Analyzing, identifying and resolving complex claims issues adversely impacting the revenue cycle management and billing process and achieving resolution through coordination and reconciliation Review and work claims in the clearinghouse & Fund EZ. Complete weekly billing batches (uploads and response files) in Electronic Health Record (MyEvolv) Understand clients’ insurance benefits utilizing ePACES, various payers’ portals. Maintain a working knowledge of OMH, OASAS, Medicare, Medicaid, Medicaid Managed Care and other payers’ billing regulations for all programs. Oversight of self-pay processing and assist with monitoring on participant outstanding balances Provide credentialing management support working with program directors to identify when changes must be made to the EHR system, incudes communicating to systems support when corrections require a process or system change.   ADDITIONAL FUNCTIONAL / ORGANIZATIONAL SUPPORT:   Understand and remain updated with current coding and billing regulations and compliance requirements Cross-train other revenue cycle areas to support and back-up the remit and denial management functional areas   QUALIFICATIONS AND ATTRIBUTES:   Detail-oriented, and able to work independently as well as on a collaborative team. Ease and comfort with numbers and calculations Working knowledge of related CPT Codes and Revenue Codes Excellent written and verbal communication skills, as well as excellent organizational and interpersonal skills. Ability to take initiative and problem-solving skills. Capable of setting priorities and ability to manage multiple projects as well as strong follow-through skills. Ability to communicate effectively with all levels of employees, including leadership as required. Proficient working with Word, Excel, PowerPoint and Electronic Medical Record Systems (MyEvolv is a plus).   EDUCATION AND EXPERIENCE:   Associate Degree from an accredited university with accounting degree preferred Knowledge of Medical Insurance programs such as Medicaid, Medicare and Dual eligibility benefits establishment. Experience with automated billing systems and familiarity with regulatory and compliance requirements and statutes Knowledge and experience with behavioral health/medical billing (Strong preference is given to candidates who have attended an accredited certificate program focused on Medical Billing).   PHYSICAL CHARACTERISTICS:   These physical demands are representative of the physical requirements necessary for an employee to perform the job's essential functions successfully. Reasonable accommodation can be made to enable people with disabilities to perform the described essential functions of the position, which are reviewed in each case. Must be capable to sit or stand in front of a computer for long-periods of time Able to work in open space floor plan Must be capable to move throughout work day and follow people served throughout community Work alongside co-workers within 3 feet Must be able to move in tight spaces Occasional lifting of > _25+ pounds