Sr Eligibility and Billing Specialist

Job Details

Job Location

Albany-Academy Main-NRFS - Albany, NY

Position Type

Full Time

Salary Range

$28.85 - $33.00 Hourly

Travel Percentage

None

Description

As a Senior Eligibility and Billing Specialist in the Finance Department, you will be responsible for eligibility review, authorization processing, communicate with providers and external billing company with tasks based on denial management, review and verification of documentation accuracy for billable services. You will report to the CFO until the Director or Revenue Cycle Management position is hired and trained. You will work onsite.

Responsibilities:

• Review and verification of services progress notes to ensure that notes have been signed, submitted, approved, and coded that there is no overlap in billable service provision.

• Review reports for potential claims not billed that meet billing requirements and identify areas of concerns in reference to loss of billing revenue due to non-billed claims.

• Collaborate with all partners providing guidance handling complex cases.

• Lead the revenue cycle team junior staff on best practices, collaborative learning and shared resources.

• Lead collaboration efforts with providers and external billing company with tasks based on denial management, review and verification of documentation accuracy for services.

• Coordinate the administrative eligibility functions of intake for service, including assisting with the processing intent to serve notifications, verifying appropriate Medicaid coverage, notifying Managed Care Organizations (MCO), and enrolling our client and client’s insurance information in the agency’s electronic health record(s).

• Provide clinical and medical provider insurance credentialing assistance to credentialing specialist to ensure cross training of responsibilities for smooth revenue cycle operation.

• Run reports in the electronic health record to support service management in critical areas of authorization and billing and any other areas identified.

• Participate in monthly or quarterly meetings with MCO to review issues or concerns regarding claims, authorization or other critical issues as they arise.

• Lead revenue cycle review with assigned program(s) and department to review findings.

  Requirements and Education:

• High School diploma required

• Three to five years of experience with Medicaid/Managed Care and commercial billing, authorization process or similar experience required

  Benefits

• Health care package: medical, dental, and vision

• Tuition reimbursement

• Paid time off

• Holiday Pay

• 401 (K) plan

• Life Insurance

• Loan repayment assistance

• Free training/CEU opportunities

  About Northern Rivers

  At Northern Rivers Family of Services, we work together to make a difference in our client's lives. Northern Rivers empowers children, adults, and families to change their lives and build stronger communities.

  Northern Rivers Family of Services is an Equal Opportunity Employer. We hire great people from a variety of backgrounds, not because it is the right thing to do, but because it makes us stronger! All applicants will be considered for employment without attention to race, color, religion, sex, orientation, gender identity, national origin, veteran or disability status, or any other characteristic protected under applicable law. We cherish the unique contributions of our diverse staff and are building a culture where everyone has the opportunity to do the meaningful work.