Job Details

Job Location
87 North Clinton Ave - Rochester, NY

Position Type
Full Time

Education Level
High School Diploma or GED

Job Shift
Day

Description

General Description

Under supervision, processes and bills medical and rent charges. Works claim denials and outstanding Invoices for all Medicaid, MCO, Commercial and County payers for agency programs. Effectively supports ongoing and collaborative communication amongst all program staff, and is responsible for ensuring a trauma informed care environment.

Starting Rate: $22.00 / hour

Essential Duties and Responsibilities

Bills medical claims for all Medicaid, MCO and Commercial Insurance payers for all assigned programs.
- Creates charges in billing system on a daily basis
- Reviews Responsible Party charges for verification of insurance and makes corrections as needed
- Requests authorizations for outpatient services when required by payer
- Reviews and corrects any front-end billing edits prior to submitting claim batches to clearinghouse by working directly with billing support when needed.
- Batches claims and uploads to clearinghouse or directly to payer
- Reviews, corrects and resubmits any clearinghouse or insurance claim rejection error messages by working directly with clearinghouse or billing support when needed.
- Completes paper claim forms (UB- 04 and HCFA1500) and mails directly to payer when needed
- Troubleshoots billing issues when necessary
Works Denials for all Medicaid, MCO and commercial payers for all assigned programs.
- Works and resolves daily denials received from all payers
- Follows up on outstanding accounts receivables for all payers
- Processes all refunds and claim adjustments requests received by compliance
- Submits refunds to payers in a timely manner to resolve credit balances
- Ensures the claims and denials are followed up on in a timely manner to ensure collection of payment
- Utilizes claims management to track and report on claim status and to ensure a timely follow-up process is followed
Performs adjustments and write offs to client accounts for all assigned programs.

Requests appropriate approval prior to processing any write offs

Adheres to all applicable federal and state laws, including but not limited to those governing client confidentiality, privacy, program standards and billing and documentation standards.
Has knowledge of federal and state standards governing program documentation and Medicaid and Medicare billing standards and completion of all required service documentation in accordance with such standards
Maintains up-to-date professional knowledge through reading, workshops/trainings and conferences, as appropriate

Participates in relevant Agency meetings and/or trainings
Actively pursues development of professional competencies related to job role performance through reading, supervision, in-service training and attendance at conferences and workshops.
Awareness and active support of the Agency's Mission, Vision, Values and Strategic Plan. Including, but not limited to, supporting the Agency's Core Competency initiatives of being Collaborative and Community Focused, Innovative and Entrepreneurial, and Culturally Competent and Diverse
Other duties as assigned

Note: The above description is illustrative of tasks and responsibilities. It is not meant to be all inclusive. Employees are required to follow appropriate supervisory direction and perform other related duties as required.

Qualifications

Qualifications

Education: Associates degree in Business Administration or Accounting or equivalent combination of education and experience.

Experience: At least 1 year accounting or client billing experience required, preferably in a non-profit setting.

Physical Demands/Work Environment: The physical demands/work environment described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.While performing the duties of this job, the employee is frequently required to sit, talk, hear, stand, walk, use hands to type and/or perform light lifting. Specific vision abilities required by this job include close vision, distance vision and ability to adjust focus.The noise level in the work environment is usually quiet.

Compliance: Adheres to all applicable federal and state laws and regulations including, but not limited to, those governing confidentiality, privacy, program, billing and documentation standards. All duties must be performed in accordance with CCFCS's corporate compliance & ethics program.

Ability to prioritize assignments, plan, and complete work projects with minimal direction,
An ability to work efficiently and effectively and meet deadlines,
An ability to work under pressure,
Excellent verbal/written skills,
Ability to maintain confidentiality,
Ability to demonstrate behaviors and attitudes which support agency mission, philosophy, and policies.
Willingness and ability to foster agency and program wide cooperation and teamwork through use of positive/constructive communication techniques,
Possession of a valid NYS Driver's license and use of a registered and reliable vehicle.

CLIENT ACCOUNT REPRESENTATIVE