Billing Representative, ELS

Job Description

Job Description

Overview

Join a Team That Changes Lives

For more than 170 years, Elwyn has been leading the way in supporting children, teens, and adults with autism, intellectual and developmental disabilities, and behavioral health challenges. As a mission-driven nonprofit, we’re here to create real change – helping people lead meaningful, fulfilling lives.

Now, we’re looking for passionate team members to join us. Here, your work will change lives – including your own. You’ll make an impact every day, find purpose in what you do, and grow in a career that truly matters.

At Elwyn, we take care of you while you care for others. We offer:

• Generous Paid Time Off
• Comprehensive Medical/Dental/Vision Benefit Packages
• Earned Wage Access/On-Demand Pay
• Paid On-the-Job Training
• Tuition Reimbursement
• Career Advancement Opportunities and Growth
• Flexible Schedules
• Retirement Savings Plan

Join us and be a part of something bigger. Apply today.

Responsibilities

Elwyn is seeking a Billing Representative to manage all medical assistance (MA)-related billing, provider payment, and reconciliation for Early Learning Services (ELS) preschool early intervention (EI) programs. This role ensures compliance with billing practices, conducts audits, provides training to contractors, and resolves billing issues.

ESSENTIAL FUNCTIONS:

Billing and Payment Management:

• Monitor and reconcile provider entries and run remittance reports to ensure proper billing and payment for assigned provider accounts
• Perform regular audits to confirm appropriate billed services and ensure accurate and timely payments
• Ensure compliance with Elwyn ELS billing practices, policies, and procedures by leveraging strong knowledge of the contractual requirements for providers

Data Integrity and Audits:

• Conduct timely analysis of agency provider/contractor data entry, daily monitoring of units of service in the database, spot checks, and data integrity audits
• Run electronic verification system (EVS) checks for MA billing eligibility through the state system

Training and Support:

• Coach, guide, and train contractors in the use of the Managed Service Portal (MSP) to enter units of service provided to ensure appropriate payment
• Provide consultation and training to providers in all billing-related matters to ensure consistency throughout the program and provide on-the-spot technical assistance

Communication and Liaison:

• Act as the primary liaison maintaining frequent communication between Elwyn Early Learning Services and providers regarding all billing-related reconciliation issues
• Communicate effectively with staff, providers, agencies, management, and office personnel from local, state, federal government, and/or its third-party contractors to reconcile any billing-related issues

Reporting and Documentation:

• Generate Medical Practitioner Authorizations (MPAs) for MA-eligible children and send them to physicians for signature authorization of services
• Compile and distribute monthly remittance files by extracting necessary data from the system database to external providers, ensuring accuracy of the service data and the rates applied

Problem Resolution:

• Analyze data inconsistencies caused by provider data entry errors and remediate the cause of the errors
• Address critical problems and communicate unresolved issues to the Lead Billing and Credentialing Specialist and/or Provider Agency for timely resolution

Other Duties:

• Perform other duties as assigned

QUALIFICATIONS, EDUCATION AND EXPERIENCE:

• High School Diploma or General Education Diploma (GED)
• Two (2) years of experience in third-party billing and collection procedures
• One (1) year of experience with Medical Assistance (MA) billing
• Experience with the School-Based Access Program preferred
• Experience with contract review preferred
• Non-profit human service experience highly preferred
• Working knowledge of computer-based billing platforms; Sprout and Pennsylvania's Enterprise to Link Information for Children Across Networks (PELICAN) preferred
• Demonstrated ability to work effectively as part of a team
• Ability to work in a fast-paced environment and manage and prioritize multiple, often competing, priorities to meet deadlines
• Strong attention to detail
• Strong time management and organizational skills
• Excellent judgment with the ability to independently solve problems and make decisions with little need for direct supervision
• Ability to anticipate future needed changes or identify problem areas and take effective actions
• Intermediate knowledge of Microsoft Office applications, including Word, Outlook, Excel, and PowerPoint
• Must possess excellent customer interaction, collaboration, presentation, and written and verbal communication