Billing Specialist

Job Description

Job Description

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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