Medical Biller

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:

. Certified Professional Coder

. Proficiency with Excel . Motivated and possess the ability to multitask . Past medical office experience necessary . Strong organization skills . Able to interact well and professionally with the public both in person and over the phone

Responsibilities:

1. Pre‑Authorizations & Verifications

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.

1. Insurance & Third‑Party Billing

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.

1. Early Intervention Program Billing (NY‑EI)

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.

1. CPSE (Pre‑School Special Education) Billing

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.

1. Documentation, Compliance & Reporting

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.

1. Coordination & Communication

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).