Billing Specialist
Location: Corona, Queens, NY
Schedule: Monday–Friday, 10:00 AM–6:00 PM, Full-Time
Salary: 55K Annually
Reports To: Billing Manager
Position Summary
The Billing Specialist is responsible for accurate and timely billing, claim follow up, denial resolution, self-pay financial assessments, and payment follow up for Medicaid, Medicare, managed care, commercial insurances and self-pay services using InSync by Qualifacts and the Inovalon clearinghouse.
Essential Duties & Responsibilities
Core duties and responsibilities include the following. Other duties may be assigned as needed.
- Verify participant’s eligibility for Medicaid, Medicare and private insurances
- Process Insurance payments to participant accounts in computerized system.
- Make sure all participants are pre certified, pre authorized, and authorization for participant SUD billing.
- Submit accurate electronic claims through InSync and Inovalon, the agency’s clearinghouse.
- Researches rejected, denied and unpaid claims; completes corrections, resubmissions, appeals and payer follow-up through resolution.
- Reviews remittance and payment information and identifies underpayments, recoupments, missing payments and posting discrepancies
- Responds to participant billing and statement inquiries.
- Makes recommendations to management for write-offs.
- Handles appeals and follow-up for managed care and out-of-network claims.
- Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully.
- Conducts financial assessments for self-pay participants in accordance with agency policies and established fee schedules.
- Explains self-pay responsibilities, payment expectations and available payment arrangements to participants.
- Monitors self-pay balances and follows up with participants regarding outstanding payments and agreed-upon payment plans.
- Maintains accurate documentation of financial assessments, payment arrangements, and participant communication and collection activity.
- Escalates delinquent accounts and recommends appropriate next steps to the Billing Manager.
- Works assigned A/R by age and timely-filing risk; documents all billing activity and follow-up dates; maintains billing and collection trackers; escalates unresolved barriers to the Billing Manager.
Qualifications
- Bachelor’s degree or existing staff with over 5 years of experience.
- Knowledge of billing software, (Preferably EPACES, Insync and Inolvalon)
- Attention to detail
- Good record keeping skills, outstanding communication skills and excellent interpersonal skills
- Must have computer skills.
Other Skills & Abilities
- Researches rejected, denied and unpaid claims; completes corrections, resubmissions, appeals and payer follow-up through resolution.
- Excellent judgment and discretion; ability to handle multiple priorities simultaneously, meet deadlines, and handle work-related stress is required.
- Friendly, courteous, service-oriented, professional, outgoing, and customer service oriented.
- Detail oriented while maintaining an extremely positive attitude.
- Must be able to work independently and productively with minimum supervision.
- Recognize problems, identify possible causes and resolve routine problems.
- Team player with a "can do" attitude that can work in a fast-paced environment.
- Ability to establish and maintain professional atmosphere for employees, participants and customers
Benefits
- 15 Vacation Days annually
- 12 Sick Days annually
- 1 Floating Holiday annually
- 401(k) Retirement Plan with 3% employer match after 90 days of employment
- Medical Insurance through Cigna after 30 days of employment
- Dental & Vision Insurance eligibility after 90 days
- Access to Gym/Weight Room
- Access to Boxing Ring
- Short-Term Disability
- Life & Accidental Insurance available through Aflac
- TransitChek for commuting expenses
- LegalShield legal services
- Potential eligibility for Public Service Loan Forgiveness (PSLF) for qualifying employees and employment
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Pay: $55,000.00 per year
Benefits:
- 401(k) matching
- Dental insurance
- Health insurance
- Paid time off
- Retirement plan
- Vision insurance
Education:
Experience:
- Medical billing: 5 years (Required)
Ability to Commute:
- Corona, NY 11368 (Required)
Work Location: In person