Shire Jobs

Agency Profile: Spectrum Health & Human Services respectfully partners with adults, children, and families as they recover from behavioral, emotional, mental health and/or substance related disorders by offering individualized and meaningful opportunities of hope, empowerment and support to achieve self-defined improvements in their quality of life.

Full-time: 227 Thorn Avenue, Orchard Park, NY

SUMMARY OF POSITION FUNCTION:

Responsible for organizing, coordinating and monitoring billing related functions as assigned by and under the direction of the Managing Director of Billing & Support Services. Maintains accounting and financial records for client and payer related activity within the electronic health records system.

MAJOR DUTIES AND RESPONSIBILITIES:

• Performs authorization verification functions’ by obtaining required information and addresses problems

• Works with site office staff to ensure that all insurance information, procedures and rules are current and adhered to

• Tracks and verifies that new client financial data is received by the billing department within 48 hours of an assessment visit

• Enters all financial related information into the EHR within a 48 hour period and verifies accuracy, staging claims to correct payers or private fee

• Confirms and enters private fee information

• Verification of allowable diagnosis based on program and billing requirements

• Assures appropriate clinical staff are assigned to clients based on insurance rules notifying site Directors of potential case transfers when necessary

• Verifies treatment plan is active and outlines proper activities to be within regulatory requirements for billing specific service types

• Works with site office staff to correct demographic information deficiencies and address problems related to claiming

• Monitors all program related billing to ensure regulatory compliance and adherence to agency submission timeframes

• Audits billing suspense reports, reaching out to necessary staff to make corrections or updates to a clients chart and/or service orders so claims are billable

• Processes Medicaid and/or 3rd Party Payer claims on a weekly or bi-weekly basis generating claim batches. Intermediate level and claim volume.

• Editing of individual claims and claim batches with but not limited to; 0fill coding and 3rd Party adjustment codes

• Submits 837 files through various EDI’s and verifies 277 acceptance files

• Follows up on all pended, denied and unpaid claims. Resubmitting claims if necessary. Intermediate level and claim volume.

• Successful completion of all billing related trainings as assigned

• Processes payments, denials and write-offs ensuring incoming revenue is accurately recorded and posted within the required time frame.

• Trains new staff and is able to offer assistance to current staff successfully as needed

• Audits private fee monthly statements, no later than 1 workday after Fiscal Closing, work schedule must accommodate this process.

• Is responsible that all coding, pricing and authorizations updates are accurately reported to the Accounts Receivable Director for programming into the EHR software.

• Adheres to Code of Ethics; reports all concerns and violations to management staff and/or Compliance Officer

• Operates office machines and instructs others in the operation of same

  SKILLS/COMPETENCIES:

• Working knowledge of all New York state Billing Regulations

• Familiarity of New York state insurance policies, including but not limited to Medicaid

• Familiarity with federal payers including but not limited to Medicare

• Excellent interpersonal and communication skills both verbal and written with the ability to make successful contacts, establishing relationships to obtain information necessary for the programs to function efficiently within the agency

• Meticulous documentation/recording skills with attention to detail; including excellent time management

• Requires strong organizational skills

• Ability to handle multiple tasks simultaneously

• Intermediate competency in the use of computer software such as MSWord, Excel, Power Point, Outlook, etc.

• Ability to operate office equipment

  EDUCATION REQUIREMENTS:

• High School Diploma or equivalent

  EXPERIENCE:

• Minimum two years medical billing experience

• Must possess a valid Driver’s License with an acceptable driving record

  COMPENSATION: $17.46/hr - $22.26/hr