Medical Biller

Job Description

Job Description

South Shore Speech is looking for a competent, responsible and dedicated individual to join our busy/fast paced, award winning team

 
Benefits and Perks:
. Family/friendly work environment
. Supportive management and staff
. Employee appreciation events regularly
. Teaching/training will be provided

 
Qualifications:

• Contact payers (e.g. Medicaid, private insurances, NICU-funded programs) to verify patient eligibility and coverage before treatment begins.
• Submit pre-authorization requests for services requiring prior approval (e.g. speech therapy visits under Early Intervention or CPSE).
• Track authorizations, monitor denials, and coordinate with clinical staff to obtain additional documentation or clinical rationale when needed.

• Prepare and submit claims to insurance carriers , including Medicaid, commercial payers, and EMR-based Early Intervention systems.
• Monitor claim status, follow up on unpaid or denied claims , and resubmit corrected or appealed claims as necessary.
• Reconcile payments, post EOBs (Explanation of Benefits) and ERA (Electronic Remittance Advice) data.
• Patient billing : handle co-pays, deductibles, and out-of-pocket balances; send statements or coordinate payment plans.

• Maintain understanding of NY State Early Intervention billing codes , rates, and service models (e.g. 1:1 vs. group, telepractice).
• Submit EI claims via the NYSED portal or billing platform used by Early Intervention providers.
• Coordinate with Service Coordinators and Special Instruction to ensure approvals and proper authorization.
• Address denials or adjustments typical to New York’s EI system, including eligibility updates and end-of-year reauthorizations.

• Handle billing through NYSED/NYCPSE mechanisms , often tied to Preschool Programs in Approved Settings (PPS or CPSE programs).
• Submit claims either directly or through school district billing systems (e.g. IU–ITP).
• Keep tabs on student eligibility, service plans (IFSP to IEP transitions), and annual authorization renewals.
• Coordinate with district CPSE liaisons and parents around covered services and parental consent.

• Maintain accurate documentation of claims, appeal letters, rejections, and patient eligibility .
• Stay current with New York health regulations, Medicaid policies, and best practices for Early Intervention and CPSE billing.
• Generate reports (e.g. productivity, claim success rates, aging schedules, AR reports) for practice management and financial tracking.

• Liaise with SLP clinicians, administrative staff, families, schools, and external coordinators (e.g. Service Coordinators, CPSE offices).
• Provide timely feedback on coverage limits, benefit exhaustion, and parental financial responsibility.
• Offer support to front-desk or intake team to collect necessary patient/payer information upfront (e.g. prior authorizations, CPSE numbers).