What are the responsibilities and job description for the Medical Billing Specialist position at Martin De Porres Youth & Family Services, Inc.?
Description:
The Medical Billing Specialist coordinates with the Authorization & Payroll Specialist and Director of Behavioral Health
Services to ensure all CFTSS and HCBS services are billed and adjudicated in accordance with New York State
Department of Health (NYSDOH) and federal regulations. The Medical Billing Specialist can work independently and
efficiently under pressure. They conduct follow-up correspondence to resolve open and denied claims via email or phone. The Medical Billing Specialist may act as a liaison between MDPYFS and the MMCPs (Medicaid Managed Care
Plans) that insure the clients on the Behavioral Health Services Department’s roster. They keep records organized and
can complete tasks quickly and efficiently, in order of highest priority.
Requirements:
MAJOR DUTIES AND RESPONSIBILITIES:
? Verify clients’ eligibility weekly.
? Maintain updated billing profiles for all clients in the clearinghouse database.
? Report service provision overutilization including but not limited to fraud, waste, and abuse.
? Process, correct, and rebill claims for adjudication using ICD-10 codes if necessary.
? Audit Explanations of Payments (EOP) from MMCPs.
? Reconcile incoming payments.
? Resolve denied and underpaid claims via the dispute, appeal, or grievance process.
? Liaise between NYS Medicaid programs and MMCPs.
? Ensure ongoing communication with the Director of Behavioral Health Services regarding the escalation of
service-impacting issues.
? Develop and implement process improvement initiatives.
? Perform ongoing independent research related to changes in industry standards.
? Attend quarterly Department meetings to provide necessary feedback.
? Perform all other duties as assigned.
QUALIFICATIONS:
EDUCATION:
? Bachelor’s Degree
EXPERIENCE:
? At least two (2) years of administrative experience
? Familiarity with billing and coding terminology
REQUIRED SKILLS AND ABILITIES:
? Excellent organizational, problem-solving, and time-management skills
? Detail-oriented and able to multitask
? Strong oral and written communication skills
? Proficiency in Microsoft Office
BACKGROUND VERIFICATION and CLEARANCE:
Section 424-A of the New York Social Services Law requires an authorized agency to inquire whether a candidate for
employment with child-caring responsibilities has been the subject of a child abuse and maltreatment report.
? Credential Verification
? Medical and Physical clearance, which includes TB screening
? State Central Registry (SCR) Clearance
? Staff Exclusion List (SEL)
? Justice Center Background Check
? Reference Verification
REQUIRED ACTIVE CERTIFICATIONS:
? Mandated Reporter
? Trauma Informed Care
? Lasallian Culture of Care
? Required training as delineated by the oversight agency and MDPYFS
EXPECTED HOURS OF WORK:
? The number of days will vary based on the agreed work schedule. The work hours are up to forty (40) hours
per week. This position may require long hours and occasional weekend work as the job demands.
PHYSICAL REQUIREMENT:
lifting requirement of 50 Lbs.
? Ability to meet physical requirements of the position when performing the following: standing, walking, sitting,
bending, stooping, squatting, kneeling, and climbing.
Salary: $25.00-$30.00/ hr
Full Time-Exempt
The Medical Billing Specialist coordinates with the Authorization & Payroll Specialist and Director of Behavioral Health
Services to ensure all CFTSS and HCBS services are billed and adjudicated in accordance with New York State
Department of Health (NYSDOH) and federal regulations. The Medical Billing Specialist can work independently and
efficiently under pressure. They conduct follow-up correspondence to resolve open and denied claims via email or phone. The Medical Billing Specialist may act as a liaison between MDPYFS and the MMCPs (Medicaid Managed Care
Plans) that insure the clients on the Behavioral Health Services Department’s roster. They keep records organized and
can complete tasks quickly and efficiently, in order of highest priority.
Requirements:
MAJOR DUTIES AND RESPONSIBILITIES:
? Verify clients’ eligibility weekly.
? Maintain updated billing profiles for all clients in the clearinghouse database.
? Report service provision overutilization including but not limited to fraud, waste, and abuse.
? Process, correct, and rebill claims for adjudication using ICD-10 codes if necessary.
? Audit Explanations of Payments (EOP) from MMCPs.
? Reconcile incoming payments.
? Resolve denied and underpaid claims via the dispute, appeal, or grievance process.
? Liaise between NYS Medicaid programs and MMCPs.
? Ensure ongoing communication with the Director of Behavioral Health Services regarding the escalation of
service-impacting issues.
? Develop and implement process improvement initiatives.
? Perform ongoing independent research related to changes in industry standards.
? Attend quarterly Department meetings to provide necessary feedback.
? Perform all other duties as assigned.
QUALIFICATIONS:
EDUCATION:
? Bachelor’s Degree
EXPERIENCE:
? At least two (2) years of administrative experience
? Familiarity with billing and coding terminology
REQUIRED SKILLS AND ABILITIES:
? Excellent organizational, problem-solving, and time-management skills
? Detail-oriented and able to multitask
? Strong oral and written communication skills
? Proficiency in Microsoft Office
BACKGROUND VERIFICATION and CLEARANCE:
Section 424-A of the New York Social Services Law requires an authorized agency to inquire whether a candidate for
employment with child-caring responsibilities has been the subject of a child abuse and maltreatment report.
? Credential Verification
? Medical and Physical clearance, which includes TB screening
? State Central Registry (SCR) Clearance
? Staff Exclusion List (SEL)
? Justice Center Background Check
? Reference Verification
REQUIRED ACTIVE CERTIFICATIONS:
? Mandated Reporter
? Trauma Informed Care
? Lasallian Culture of Care
? Required training as delineated by the oversight agency and MDPYFS
EXPECTED HOURS OF WORK:
? The number of days will vary based on the agreed work schedule. The work hours are up to forty (40) hours
per week. This position may require long hours and occasional weekend work as the job demands.
PHYSICAL REQUIREMENT:
lifting requirement of 50 Lbs.
? Ability to meet physical requirements of the position when performing the following: standing, walking, sitting,
bending, stooping, squatting, kneeling, and climbing.
Salary: $25.00-$30.00/ hr
Full Time-Exempt
Salary : $25 - $30
Billing Specialist-78319-027
Mount Sinai Health Systems -
Elmhurst, NY