Billing Specialist jobs at Arnot Health - 535 jobs
Pre Authorization Representative - Case Mgmt
Arnot Ogden Medical Center 4.8
Billing specialist job at Arnot Health
MAIN FUNCTION: Works within a team environment pre-authorizing exams for various hospital services. This position will require a degree of complexity and prior anatomy education. DUTIES AND RESPONSIBILITIES: COMMUNICATION: 1. Promptly answers the telephone in a professional and courteous manner.
2. Demonstrates the knowledge and ability to utilize various computer networks and telephone applications to procure pre-authorizations for patients.
3. Demonstrates the ability to complete pre-authorizations in a timely manner.
4. Demonstrates the ability to communicate courteously and effectively with internal and external customers.
5. Demonstrates an understanding of both CPT , ICD9 and medical terminology.
6. Demonstrates the ability to check appointment schedules daily to ensure that all admissions and procedures have been approved (pre-authorized) by the insurance carrier.
CLERICAL:
7. Demonstrates insurance knowledge.
8. Demonstrates knowledge of ICD-9 coding / CPT / HCPCs to ensure Arnot Health to receive the maximum reimbursement that is allowable.
9. Demonstrates knowledge of Medicare requirements for approved ICD-9 codes and to communicate to the provider when a code is not approved, and knowledge of Medicare waivers.
10. Demonstrates the ability to accurately pre-authorize / pre-certify patients exams for all departments to ensure the smooth daily operation of the department..
11. Has knowledge of the method of proper sequencing of exams (ie. prioritization).
12. Communicates all questions to the appropriate department.
13. Has ability to conference with other departments to bring about conflict resolution to pre-authorization problems.
14. Demonstrates the ability to be cross-trained to other responsibilities of the department as required by the Supervisor/Director.
COMPUTER:
15. Demonstrates basic computer skills.
16. Demonstrates the knowledge and ability to work within the Arnot Health's computer system.
17. Maintains computer security.
WORKING RELATIONSHIP:
18. Has general knowledge of the Hospital's departments and how these departments interact with each other.
19. Interacts with physician and physician's offices in a positive and courteous manner.
20. Establishes and maintains collaborative working relationships with other health team members.
21. May perform other duties as requested by supervisor/manager which contributes to the smooth operation of the department.
QUALITY:
22. Demonstrates reliability in the conscientious, complete and accurate manner in which work assignments are performed.
23. Demonstrates Quality Improvement principles in daily work and participates in QI monitoring and reporting.
QUANTITY:
24. Demonstrates flexibility in work schedule to meet the needs of the department.
25. Demonstrates the ability to perform multiple tasks as required by the position.
26. Continuously utilizes time to maximize full potential, sets priorities and is uses good organizational skills.
SAFETY:
27. Functions within an awareness of risk management and safety issues, reports concerns appropriately.
28. Maintains complete understanding of the Arnot Health's emergency codes.
PROFESSIONALISM:
29. Is accountable for own actions.
30. Maintains professional behavior and appearance. Wears Arnot Health's ID Badge.
31. Maintains and respects patients and patient confidentiality.
32. Addresses internal and external customers in a pleasant and respectful manner, displaying courtesy at all times.
33. Attends staff meetings.
OTHER:
34. Is responsible for attending all annual mandatory educational programs as required by position.
35. Employee understands and demonstrates the importance of satisfying the needs of the customer/patient by interacting with him/her in a friendly and caring way, being attentive to the customer's needs, both psychologically and physically, and by taking the initiative to maintain communication with the customer in order to provide a secure and pleasant experience with Arnot Health.
36. It is understood that this job description lists typical duties for the classification and is not to be considered inclusive of all duties that may be assigned
EDUCATION:
Mandatory: Clinical experience in various areas is needed/and or coding in various areas. ICD9/CPT coding certifications or prior billing experience.
High School graduate or equivalent. Hospital experience preferred.
EXPERIENCE:
1. Good organizational, communication, and customer relations skills.
2. Telephone courtesy.
3. Service oriented experience preferred.
CARDIOPULMONARY RESUSCITATION (CPR) REQUIREMENTS:
No CPR required.
PHYSICAL DEMANDS:
Light physical effort. Typical office job.
EXPOSURE CATEGORY:
Category III. Tasks that involve no exposure to blood, body fluids, or tissues. Category I tasks are not a condition of employment.
A.D.A. Essential Functions
$47k-56k yearly est. 13d ago
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Physician Specialist
NYC Health + Hospitals/Correctional Health Services 4.7
New York, NY jobs
New York City Health and Hospitals Corporation
Outposted Therapeutic Housing Units Program (OTxHU)
Since 2016, Correctional Health Services (CHS) has been the direct provider of health care in the New York City jails. Deeply committed to human dignity and patient rights, CHS is part of the NYC Health + Hospitals system and is a key partner in the City's efforts to reform the criminal-legal system. Our in-jail clinical services include medical, nursing, and mental health care; pharmacy services; substance-use treatment; social work; dental and vision care; discharge planning; and reentry support.
Given the high visibility of this initiative, we are seeking the highest caliber health care professionals in key clinical services to staff our Outposted Therapeutic Housing Units (OTxHU). To be located in three NYC Health + Hospital acute care facilities, the OTxHU is a pioneering approach to safely increasing access to high quality clinical care for patients in custody who have complicated health conditions. OTxHUs will bridge the gap in the continuum between care provided in the jails and inpatient hospitalization, with admission to and discharge from the OTxHU in accordance with a patient's clinical needs. CHS will be the primary health care providers on these units and the NYC Department of Correction will provide security and custody management.
The OTxHU at NYC Health + Hospitals/Bellevue in Manhattan will be the first of this unique, groundbreaking project to open with a planned completion date as early as the end of 2024. This is an incredible opportunity to be part of a passionate and motivated team providing care to some of the City's most marginalized, vulnerable people.
*To help support continuity of operations and care, staff selected to work in the OTxHU may also be required to work in CHS locations within the jails. Additionally, while CHS seeks the most qualified individuals for these positions, preference will be given to equally qualified, internal candidates.
Time: 08:00 AM - 05:00 PM
Days: Mon,Tue,Wed,Thu,Fri
Location: OTxHU- Bellevue/Rikers Island
Under supervision of the Site Medical Director, the Physician will provide comprehensive, compassionate, and thoughtful care to patients with complex chronic disease in the New York City jail system. The Physician will be part of a core interdisciplinary team working in a unique environment delivering the care to patients with significant chronic illnesses. The Physician will provide general primary care including conducting histories and physicals, diagnosing and treating acute and chronic illnesses, and evaluating the need for consult services. The interdisciplinary team will work under supervision of a Site Medical Director.
Responsibilities include:
Diagnose and treat acute and chronic illnesses. Evaluate the need for consult services and submit the prioritized consult when indicated.
Complete comprehensive histories and physicals on all new admissions including documentation of problem list, diagnosis, orders (e.g. labs, imaging and referrals) and ordering appropriate medications where applicable.
Evaluate patients requesting sick call, schedule follow-ups and update medication orders. Update problem lists and reconcile patient orders at all visits.
Implement plans for patient care utilizing protocols approved by the medical leadership and/or treatment plans reflecting the current standard of care.
Request radiology exams, lab tests, EKGs when clinically indicated and interpret these results based on clinical findings and in consultation with supervisors where appropriate.
Collaborate closely with CHS Physician Assistants, including providing clinical guidance, cosigning notes, and providing other supervision based on clinical circumstance and PA requirements.
Review all specialty consults and hospital returns to ensure that the standard of care is met and recommendations of the consultant are implemented.
Perform chart reviews and summaries for patients transferring facilities including updating problem lists, rewriting medication orders, and reconciling orders and consults as needed.
Generate special needs referrals and documentation as needed (for patients with (disabilities, dietary restrictions, heat sensitivity, or other relevant flags).
Teach patients about their medical conditions and treatments; counsel on risks and benefits of different treatment decisions; witness, sign, and document patient refusals of care.
Ensure that all progress notes and orders are signed before the end of the shift.
Respond to emergencies in a timely and professional manner.
Notify the appropriate parties, including Urgicare, about 3-hour runs and EMS activation.
Complete special housing rounds when assigned.
Be familiar with quality of care and population health indicators. Take appropriate action to meet or exceed standards.
Maintain clinical competency by participating in all CME and CHS training and in-service requirements.
Maintain your schedule as directed with particular attention to punctuality and timely notification of absences.
Adhere to policies and procedures of CHS and be familiar with them by reviewing them as needed.
Complete tasks as delegated by a Site Medical Director or other supervising clinical team member.
Maintain all required credentials.
Maintain current licensure and CME requirements (Appropriate documentation must be on our files).
Maintain professional attitude and appearance.
Adhere to Occupational Health Services requirements.
Minimum Qualifications
1. Graduation from an approved medical school.
2. Completion of approved residency or fellowship in the specialty or sub-specialty and Board eligible or certified or Subboard eligible or certified.
3. Five years experience in field of specialty or subspecialty acceptable to the Medical Board of the Hospital.
4. Licensed to practice medicine in the State of New York.
Department Preferences
Three to five years' work experience, which may include residency in a directly related medical specialty
Experience working with patients in a skilled nursing facility or other residential setting
Experience working with patients who have serious mental illness
Experience working with patients who carry substance use diagnoses; knowledge of harm reduction approaches to care; and familiarity with medications to treat opioid use disorder
Experience leading quality improvement initiatives
Understanding of trauma-informed care
Skilled in patient-centered shared decision making
Skilled in communicating risks and benefits of clinical interventions and assessing capacity to make informed decisions.
Completion of residency in internal medicine, family medicine or other primary care-oriented specialty.
Compliance with appropriate Maintenance of Certification requirements or other Board Certification requirements.
Excellent interpersonal communication skills and ability to work collaboratively within a multidisciplinary team, as well as with NYC DOC staff
NYC Health and Hospitals offers a competitive benefits package that includes:
Comprehensive Health Benefits for employees hired to work 20+ hrs. per week
Retirement Savings and Pension Plans
Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts
Loan Forgiveness Programs for eligible employees
College tuition discounts and professional development opportunities
College Savings Program
Union Benefits for eligible titles
Multiple employee discounts programs
Commuter Benefits Programs
$120k-240k yearly est. 5d ago
Patient Advocate - Patient Safety - Full Time
Guthrie 3.3
Binghamton, NY jobs
The Patient Experience Representative influences the systems, processes and behaviors that cultivate positive experiences across the continuum of care. They have an unwavering commitment to the field of patient experience and to transforming human experience in healthcare.
Experience:
Minimum 3 Years' Experience In a Healthcare Setting Required.
Education, License & Certification:
Associate degree preferred or 5 years direct experience in a role of advocate in healthcare setting.
Registered Nurse or other Healthcare related licensure preferred.
Certified Patient Experience Professional (CPXP) required, or within 3.5 years of hire.
Essential Functions:
Advocates for the needs of our patients and their representatives in a proactive, inclusive, empathetic, and positive manner.
Supports organizational learning and a holistic approach to our patient's needs.
Provides guidance for new or inexperienced caregivers related to patient-service recovery.
Collaborates with all caregivers to improve processes that directly impact patient and community perception.
Oversees the internal system for managing patient/representative concerns and maintains applicable regulatory body compliance.
Provides data analysis to identify trends specific to patient experience and develops corrective action plans based on those trends.
Actively participates on or leads workgroups or committees related to patient advocacy.
Supports the design and innovation of the Patient Family Advisory Council.
Works collaboratively with the Patient Safety and Legal Departments.
Other Duties:
Travel for this position is sometimes required.
It is understood that this description is not intended to be all‐inclusive and that other duties may be assigned as necessary in the performance of this position.
update 1-13-25
About Us
Joining the Guthrie team allows you to become a part of a tradition of excellence in health care. In all areas and at all levels of Guthrie, you'll find staff members who have committed themselves to serving the community.
The Guthrie Clinic is an Equal Opportunity Employer.
The Guthrie Clinic is a non-profit, integrated, practicing physician-led organization in the Twin Tiers of New York and Pennsylvania. Our multi-specialty group practice of more than 500 physicians and 302 advanced practice providers offers 47 specialties through a regional office network providing primary and specialty care in 22 communities. Guthrie Medical Education Programs include General Surgery, Internal Medicine, Emergency Medicine, Family Medicine, Anesthesiology and Orthopedic Surgery Residency, as well as Cardiovascular, Gastroenterology and Pulmonary Critical Care Fellowship programs. Guthrie is also a clinical campus for the Geisinger Commonwealth School of Medicine.
$35k-43k yearly est. 4d ago
Patient Access Representative - Central Scheduling - Full Time
Guthrie 3.3
Vestal, NY jobs
Communicates with patients, participants and staff to accurately schedule patients for prescribed procedures. Performs clerical and reception duties associated with patient registration. Education, License & Cert: High School Diploma or equivalent is required.
Experience:
- Customer/patient relations experience required (preferably in a healthcare setting).
- At least 1‐year experience in a position requiring frequent and direct in‐person customer contact.
- Candidate should have experience in a role that requires:
• Strong organizational skills
• Excellent verbal communication skills
• Frequent keyboarding
• Exceptional attention to detail
Essential Functions:
1. Creates patient encounters in the EHR for ED, radiology, and outpatient patients. Performs all functions related to the integrity of the EHR (i.e., obtaining general consent for treatment, creating unknown encounters, merging records, scanning, prepared trauma packets)
2. Participates in daily auditing of registration processes.
3. Manages incoming and outgoing telephone calls, Vocera calls, Nurse call system.
4. Collects co‐pays and provides financial guidance related to paying outstanding balances, providing estimate letters for services rendered.
5. Performs the function of Health Information Management department after hours.
6. Participates in ED staff meetings and ED Shared Governance.
Other Duties:
Other duties as assigned.
The pay range for this position is $17.00 - $22.37/hour
$17-22.4 hourly 4d ago
RCM Specialist
Aspen Dental 4.0
East Syracuse, NY jobs
The Aspen Group (TAG) is one of the largest and most trusted retail healthcare business support organizations in the U.S., supporting 15,000 healthcare professionals and team members at more than 1,000 health and wellness offices across 47 states in three distinct categories: Dental care, urgent care, and medical aesthetics. Working in partnership with independent practice owners and clinicians, the team is united by a single purpose: to prove that healthcare can be better and smarter for everyone. TAG provides a comprehensive suite of centralized business support services that power the impact of five consumer-facing businesses: Aspen Dental, ClearChoice Dental Implant Centers, WellNow Urgent Care, Lovet Pet Health Care and Chapter Aesthetic Studio. Each brand has access to a deep community of experts, tools and resources to grow their practices, and an unwavering commitment to delivering high-quality consumer healthcare experiences at scale.
As a reflection of our current needs and planned growth we are very pleased to offer a new opportunity to join our dedicated team as Revenue Cycle Management Specialist based in our East Syracuse, NY office.
Essential Responsibilities:
RCM Specialists care for the people who care for our patients by performing insurance adjudication, customer service, and patient collection job functions that require superior service and attention to detail.
Bring better care to the front lines by supporting the execution and achievement of functional areas and company goals.
Partners with internal departments to resolve issues related to all tasks and assignments supporting the business.
Point of contact for internal and external customer inquiries, which entails contacting insurance companies and/or addressing patient inquiries.
Uses software and company systems to source, obtain, process, audit and analyze standard data reporting and presenting.
Plans, organizes, and executes tasks and activities with urgency and in accordance with managers' delegated assignments.
Responds to and resolves issues related to claim adjudication, patient and billing inquiries, while seeking managers guidance for non-routine inquiries or escalated concerns.
May be required to meet position related productivity and quality standards.
Other duties as assigned.
Requirements/Qualifications:
Education Level: High School diploma or equivalent.
Job related/Industry experience preferred.
Excellent verbal and written communication skills.
Excellent organizational and time management skills.
Excellent problem solving/analysis collaboration.
Self-motivated individual with strong attention to detail.
Leadership experience preferred.
Additional Details:
Base Pay Range: $17.00 - 21.00 per hour (Actual pay may vary based on experience, performance, and qualifications.)
This position will be based on-site in our East Syracuse, NY office working a hybrid schedule of 4 days/week and 1 day remote.
A generous benefits package that includes paid time off, health, dental, vision, and 401(k) savings plan with match.
$17-21 hourly 1d ago
Billing Specialist (Hybrid)
St. Anns Community 3.8
Rochester, NY jobs
Join us in caring for the most important people on Earth! We reward hard-working and caring professionals with competitive pay, great benefits and career growth opportunities.
St. Ann's Community Management Company, Inc. (SAMCI) is currently looking to hire a BillingSpecialist to accurately process Fee Revenues for Agency through to timely collection. This position involves a “hybrid” work schedule; working occasionally remotely or onsite with Clients.
St. Ann's Community Offers:
Hybrid work schedule
Pay Range - $17.50/hr. - $21.90/hr.
Tuition Reimbursement and Scholarship Opportunities
Dental, Health & Vision
403(b) Retirement Plan
Opportunities for growth and advancement
Job Description:
Exercises full compliance with the St. Ann's Community Code of Conduct, policies and procedures
Maintain Clearinghouse and/or Electronic Medical Record as needed for all eligibility and billing needs
Prepares and submits billing claims which include posting monthly receipts and adjustments, reconciling receipts, preparing refunds, and processing monthly statements.
Performs routine analysis and ensures proper procedures related to Medicare, Medicaid and other third-party payers
Proactively works aging reports and write appeal letters when applicable
Prepares All Third-Party Insurance bills for submission or patient billing
Data Entry of Cash Receipts by Entity
Responds to patients and responsible parties' billing questions.
Identify issues attributing to account delinquency and communicate with Supervisor
Candidate Requirements:
Local candidates only
Associate's Degree with One (1) to Two (2) years of billing and computer experience
Medical Billing Certification preferred
Knowledge of Medical Billing or equivalent Required
Must obtain Medical Billing certification within one year of employment. Employer paid certification with 2 year commitment
Must maintain active Medical Billing certification while employed with SAMCI. This includes completing required continuing education credits.
Join us in Caring for the Most Important People on Earth
The employment policy of St. Ann's Community is to provide equal opportunity to all persons. Our company, therefore, has made a commitment to equal employment opportunity through a positive and continuing Affirmative Action Program. No employee or applicant for employment will be discriminated against because of race, color, religion, sex, national origin, age, disability, veteran status or any other Federal or State legally-protected classes.
$17.5-21.9 hourly 7d ago
Customer Service Billing Associate I
Albany Medical Health System 4.4
Albany, NY jobs
Department/Unit: AMHS - Self Pay Billing Office Work Shift: Day (United States of America) Salary Range: $40,495.10 - $52,643.64 The SBO Customer Service Billing Associate is responsible for providing customer service to patients and families who have received services at any of the five main campus locations within the Albany Med Health System including 125 + practice locations. The department is responsible for $65-70M in total Self-Pay AR. The Customer Service Billing Associate is the primary point of contact for customer/patient inquiries, receiving in excess of 100 calls per day. This position collects payments, assists with insurance inquiries, provides account status, and will escalate calls to management as needed. This role requires professional communication, accuracy, and problem-solving skills.
Essential Duties and Responsibilities
* Manage inbound and outbound calls with professionalism and empathy, addressing customer inquiries, including those related to CRM systems-to ensure accurate and timely support
* Assist patients in reviewing and selecting appropriate payment plan options within the Albany Med Health System guidelines, including guidance on available Financial Aid programs
* Maintain strong listening skills; ability to de-escalate in difficult or emotional customer interactions.
* Review credit balances; process refund requests.
* Accurately update, add, or remove patient insurance and demographic information to ensure up-to-date records and seamless billing processes and identify root causes of data discrepancies
* Manage assigned work queues and perform intradepartmental workflow tasks as needed to support efficient operations and cross-functional collaboration
* Meet daily/weekly productivity standards with acceptable QA results.
* Manage a cash drawer as needed.
* Process attorney, internal, bankruptcy, and insurer requests in accordance with organizational policies and regulatory requirements
* Perform cross-functional coordination with billing, legal, and insurance teams to ensure accurate processing and issue resolution
* Additional responsibilities as required
Qualifications
* High School Diploma/G.E.D. - required
* Associate's Degree - preferred
* 1-2 years of relevant customer service or support experience - preferred
* Proven capability to self-manage and take initiative in completing assignments with accountability
* Excellent verbal and written communication
* Strong attention to detail; ability to follow processes accurately
* Basic understanding of relevant financial/billing terms
* Effectively defuse high-stress customer interactions to achieve positive outcomes
* Familiarity with CRM or customer support software
* Ability to manage time effectively and complete multiple tasks timely
* Some medical terminology knowledge
Equivalent combination of relevant education and experience may be substituted as appropriate.
Physical Demands
* Standing - Occasionally
* Walking - Occasionally
* Sitting - Constantly
* Lifting - Rarely
* Carrying - Rarely
* Pushing - Rarely
* Pulling - Rarely
* Climbing - Rarely
* Balancing - Rarely
* Stooping - Rarely
* Kneeling - Rarely
* Crouching - Rarely
* Crawling - Rarely
* Reaching - Rarely
* Handling - Occasionally
* Grasping - Occasionally
* Feeling - Rarely
* Talking - Constantly
* Hearing - Constantly
* Repetitive Motions - Frequently
* Eye/Hand/Foot Coordination - Frequently
Working Conditions
* Extreme cold - Rarely
* Extreme heat - Rarely
* Humidity - Rarely
* Wet - Rarely
* Noise - Occasionally
* Hazards - Rarely
* Temperature Change - Rarely
* Atmospheric Conditions - Rarely
* Vibration - Rarely
Thank you for your interest in Albany Medical Center!
Albany Medical Center is an equal opportunity employer.
This role may require access to information considered sensitive to Albany Medical Center, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that: Access to information is based on a "need to know" and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Medical Center policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.
Thank you for your interest in Albany Medical Center!
Albany Medical is an equal opportunity employer.
This role may require access to information considered sensitive to Albany Medical Center, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that:
Access to information is based on a "need to know" and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Med Center policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.
$40.5k-52.6k yearly Auto-Apply 9d ago
Customer Service - Clifton Park
Vent Fitness 3.9
Clifton Park, NY jobs
Passion / Integrity / Professionalism / Customer Service
Are you a People Person?
Our customer service team is responsible for being the first point of contact for new and existing members. The first person a member sees when they arrive and the last person they see when leaving, our customer service team sets the tone for our members experience while at the club. Our team members are fully versed on club operations and services and have one of the busiest positions in the club.
Attention to detail, professionalism and passion are key attributes of the ideal candidate. In addition to greeting and interacting with members, our customer service team serves protein shakes, operates cash register, assists with member tours and questions, enrolls members in fitness classes and sessions, handles incoming phone calls and assists with cleaning in our facility. Team members in this position are typically cross trained to perform many different functions.
Prior experience in a fast paced retail business is helpful. Fitness minded individuals are encouraged to apply. This position provides opportunity for advancement into personal training, group Exercise instruction and management.
EOE
$25k-32k yearly est. 60d+ ago
Medical Billing and Coding Associate II
Ambulnz 3.9
New York jobs
Title: Medical Coding Associate II Employment Type: Full-Time, Hourly
Pay Range: $25 - $30 per hour (based on experience)
Benefits: Medical, Dental, and Vision (with company contribution), PTO Paid Time Off, Weekly pay, 401k
About DocGo:
DocGo is leading the proactive healthcare revolution with an innovative care delivery platform that includes mobile health services, population health, remote patient monitoring, and ambulance services. DocGo disrupts the traditional four-wall healthcare system by providing high quality, highly affordable care to patients where and when they need it. DocGo's proprietary, AI-powered technology, logistics network, and dedicated field staff of over 5,000 certified health professionals elevate the quality of patient care and drive efficiencies for municipalities, hospital networks, and health insurance providers. With Mobile Health, DocGo empowers the full promise and potential of telehealth by facilitating healthcare treatment, in tandem with a remote physician, in the comfort of a patient's home or workplace. Together with DocGo's integrated Ambulnz medical transport services, DocGo is bridging the gap between physical and virtual care.
Position Overview:
We are seeking a skilled and detail-oriented Medical Billing and Coding Associate with a primary focus on coding to join our team. The ideal candidate will possess expertise in medical coding, including ICD-10, CPT, and HCPCS coding systems, and will play a vital role in ensuring accurate coding and billing practices.
Responsibilities:
Medical Coding
Assign appropriate ICD-10, CPT, and HCPCS codes to diagnoses, procedures, and services rendered by healthcare providers.
Review medical records and documentation to accurately assign codes and ensure compliance with coding guidelines and regulations.
Conduct regular audits to identify coding errors and discrepancies and implement corrective measures as needed.
Documentation Improvement:
Provide feedback and education to healthcare providers and staff on documentation improvement opportunities to support accurate coding and billing practices.
Stay updated on changes in coding guidelines, regulations, and reimbursement policies and communicate updates to relevant stakeholders.
Quality Assurance:
Perform quality assurance reviews of coded medical records to ensure compliance with coding standards and accuracy in code assignment.
Collaborate with compliance and auditing teams to address coding-related issues and implement best practices for quality improvement.
Other:
Other tasks as assigned
Qualifications:
Certified Coding Specialist (CCS), Certified Professional Coder (CPC), or equivalent coding certification required.
Minimum of 2 years of experience in medical coding, with a focus on ICD-10, CPT, and HCPCS coding systems.
Proficiency in medical terminology, anatomy, and physiology.
Strong understanding of healthcare reimbursement methodologies and regulatory requirements.
Excellent attention to detail and accuracy in code assignment.
Effective communication and interpersonal skills, with the ability to collaborate with multidisciplinary teams.
Proficiency in coding software and electronic health record (EHR) systems.
EEO/AAP Statement: DocGo is an equal opportunity employer. We acknowledge and honor the fundamental value and dignity of all individuals. We pledge ourselves to crafting and maintaining an environment that respects diverse traditions, heritages, and experiences. DocGo is an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.
The above-noted job description is not intended to describe, in detail, the multitude of tasks that may be assigned but rather to give the applicant a general sense of the responsibilities and expectations of this position. As the nature of business demands change so, too, may the essential functions of the position.
$25-30 hourly Auto-Apply 10d ago
Nursing Home Billing Specialist
Teresian House 3.8
Albany, NY jobs
Job Description
The Teresian House is currently hiring. This opportunity is a Full Time Day position, working 8 am-4 pm! Thank you for considering Teresian House in your choice for employment!
The Nursing Home BillingSpecialist is responsible for:
Timely insurance verification of all referrals for potential admission to the facility.
Ensuring accurate and timely billing of all services rendered to residents in compliance with NYS Medicaid, Medicare, Mafae Care Organizations (MCO's) and private insurance.
Preparing and submitting claims, resolving billing issues, managing accounts receivable, and working with families and third-party payers to ensure proper reimbursement.
Verifying resident insurance eligibility and insurance coverage using Availity, Epaces and other electronic systems daily.
Preparing and submitting timely billing for Medicare, MCO's, Medicaid and private insurers using electronic and payer formats. Monitor and manage outstanding balances and follow-up on unpaid claims.
Communicating with families, residents and insurance companies regarding account status and unpaid claims.
Maintaining up to date knowledge of Medicare, MCO and NYS Medicaid regulations and billing practices.
Working with other departments to ensure accurate census date and payer sources are maintained.
Assisting with audits and providing requested documentation for compliance and financial reviews.
Maintain accurate and confidential billing records in accordance with HIPAA regulations.
Qualifications:
High School Diploma or GED required. Associate's Degree in Accounting, Business or related field experience preferred.
2+ years of billing experience in a skilled nursing facility (SNF) or healthcare setting
Strong knowledge of Medicare Part A/B, MCO's, NYS Medicaid and commercial billing.
Experience with billing software - Point Click Care
Proficient in Excel and data entry
Excellent communication and organizational skills
Ability to manage multiple tasks and meet deadlines
Knowledge of HIPAA regulations and healthcare confidentiality standards.
Preferred Skills:
Previous Nursing Home Billing experience.
Knowledge of claims and experience resolving billing issues.
Experience with SNF benefits specific to rehabilitation.
Knowledge of NYS Medicaid application process.
Do you want to join a team committed to enhancing the lives of our residents by providing optimal service in a homelike atmosphere? We invite you to join our team and reap the benefits of becoming part of the Teresian House family:
Excellent starting pay rate with competitive and generous benefits
Generous paid time off with cash-in options
Cost-shared health, dental, and optical insurance with a significant employer paid share
Opportunity for career pathways
Retirement plan with employer match
Free meal daily
Fully paid group life insurance
Employee Assistance Plan including individual counseling and referral to community services
Tuition assistance and scholarships!
Our mission is evident in the daily interactions our staff have with residents and their families. At Teresian House, we are truly "Where the spirit of love and dedication lives..."
$33k-42k yearly est. 15d ago
820 Billing Specialist - Part-Time!
Odyssey House Inc. 4.1
New York, NY jobs
SCHEDULE: Only Mondays, Wednesdays and Fridays from 9am-5pm
REPORTS TO: Director of Revenue Cycle
DEPARTMENT: Finance
Our Mission:
Since 1967, Odyssey House has been providing innovative services and programs to a broad population of individuals and families struggling with substance use and mental health disorders. Odyssey House helps New Yorkers of all ages-and across all five boroughs-beat drugs and alcohol with highly individualized treatment programs. Odyssey House provides high quality, holistic treatment impacting all major life spheres, including: psychological, physical, social, family, educational and spiritual in order to support personal rehabilitation, renewal and family restoration.
If that sounds different than other treatment programs, you're right. Because Odyssey is where recovery gets real.
In addition to competitive salaries, Odyssey House offers:
A 35-hour work week (as opposed to a 40-hour work week)
Vacation Plan and Holiday Schedule
Life Insurance
Medical Insurance (Two Plans)
Dental and Vision Insurance
Additional Insurance Coverages (hospitalization, accidental, critical illness coverage)
Long-Term & Short-Term Disability
Flexible Spending Account/Health Reimbursement Account
403(b) Plan
Corporate Counseling Associates (CCA) EAP benefit
Ability Assist Counseling Services (through The Hartford)
Commuter Benefits
Educational Assistance Programs
Special shopping discounts through ADP Marketplace and PlumBenefits
RUFit?! Fitness Program
Legal Assistance through ARAG
Optum Financial Service through ConnectYourCare
Benefit Advocacy Center through Gallagher
MAJOR FUNCTION:
The 820 Billing Assistant is responsible for assisting billing team with collection of Managed Care Organization payments.
SPECIFIC DUTIES & RESPONSIBILITIES:
Reconcile client number of days stay between AWARDS and Census Reports
Verify accuracy of clients' health insurance in AWARDS through ePaces
Access real-time payer portals to verify accuracy in authorization ID entered in AWARDS
Verify and confirm appropriate diagnosis and procedure coding as per clinical documentation
Navigate payee websites/portals to keep track payments or denials
Works closely with co-workers to analyze and identify issues
Calling insurance companies to research the reason for denials
Post payments in AWARDS database
REQUIREMENTS:
Excellent analytical, problem solving, and interpersonal and communication skills
Proficiency in Microsoft Excel
Must be able to work independently and with a team
Odyssey House is an equal opportunity employer maintaining a non-discriminatory policy on hiring of its personnel. Odyssey House, and its operational divisions, will not discriminate against any employee or applicant because of race, creed, color, national origin, sex, disability, marital status, sexual orientation or citizen status in all employment decisions including but not limited to recruitment, hiring, upgrading, demotion, downgrading, transfer, training, rate of pay or other forms of compensation, layoff, termination and all other terms and conditions of employment.
$32k-39k yearly est. Auto-Apply 60d+ ago
820 Billing Specialist - Part-Time!
Odyssey House Inc. 4.1
New York, NY jobs
SCHEDULE: Only Mondays, Wednesdays and Fridays from 9am-5pm
REPORTS TO: Director of Revenue Cycle
DEPARTMENT: Finance
Our Mission:
Since 1967, Odyssey House has been providing innovative services and programs to a broad population of individuals and families struggling with substance use and mental health disorders. Odyssey House helps New Yorkers of all ages-and across all five boroughs-beat drugs and alcohol with highly individualized treatment programs. Odyssey House provides high quality, holistic treatment impacting all major life spheres, including: psychological, physical, social, family, educational and spiritual in order to support personal rehabilitation, renewal and family restoration.
If that sounds different than other treatment programs, you're right. Because Odyssey is where recovery gets real.
In addition to competitive salaries, Odyssey House offers:
A 35-hour work week (as opposed to a 40-hour work week)
Vacation Plan and Holiday Schedule
Life Insurance
Medical Insurance (Two Plans)
Dental and Vision Insurance
Additional Insurance Coverages (hospitalization, accidental, critical illness coverage)
Long-Term & Short-Term Disability
Flexible Spending Account/Health Reimbursement Account
403(b) Plan
Corporate Counseling Associates (CCA) EAP benefit
Ability Assist Counseling Services (through The Hartford)
Commuter Benefits
Educational Assistance Programs
Special shopping discounts through ADP Marketplace and PlumBenefits
RUFit?! Fitness Program
Legal Assistance through ARAG
Optum Financial Service through ConnectYourCare
Benefit Advocacy Center through Gallagher
MAJOR FUNCTION:
The 820 Billing Assistant is responsible for assisting billing team with collection of Managed Care Organization payments.
SPECIFIC DUTIES & RESPONSIBILITIES:
Reconcile client number of days stay between AWARDS and Census Reports
Verify accuracy of clients' health insurance in AWARDS through ePaces
Access real-time payer portals to verify accuracy in authorization ID entered in AWARDS
Verify and confirm appropriate diagnosis and procedure coding as per clinical documentation
Navigate payee websites/portals to keep track payments or denials
Works closely with co-workers to analyze and identify issues
Calling insurance companies to research the reason for denials
Post payments in AWARDS database
REQUIREMENTS:
Excellent analytical, problem solving, and interpersonal and communication skills
Proficiency in Microsoft Excel
Must be able to work independently and with a team
Odyssey House is an equal opportunity employer maintaining a non-discriminatory policy on hiring of its personnel. Odyssey House, and its operational divisions, will not discriminate against any employee or applicant because of race, creed, color, national origin, sex, disability, marital status, sexual orientation or citizen status in all employment decisions including but not limited to recruitment, hiring, upgrading, demotion, downgrading, transfer, training, rate of pay or other forms of compensation, layoff, termination and all other terms and conditions of employment.
$32k-39k yearly est. Auto-Apply 60d+ ago
820 Billing Specialist - Part-Time!
Odyssey House Inc. 4.1
New York, NY jobs
Job Description
SCHEDULE: Only Mondays, Wednesdays and Fridays from 9am-5pm
REPORTS TO: Director of Revenue Cycle
DEPARTMENT: Finance
Our Mission:
Since 1967, Odyssey House has been providing innovative services and programs to a broad population of individuals and families struggling with substance use and mental health disorders. Odyssey House helps New Yorkers of all ages-and across all five boroughs-beat drugs and alcohol with highly individualized treatment programs. Odyssey House provides high quality, holistic treatment impacting all major life spheres, including: psychological, physical, social, family, educational and spiritual in order to support personal rehabilitation, renewal and family restoration.
If that sounds different than other treatment programs, you're right. Because Odyssey is where recovery gets real.
In addition to competitive salaries, Odyssey House offers:
A 35-hour work week (as opposed to a 40-hour work week)
Vacation Plan and Holiday Schedule
Life Insurance
Medical Insurance (Two Plans)
Dental and Vision Insurance
Additional Insurance Coverages (hospitalization, accidental, critical illness coverage)
Long-Term & Short-Term Disability
Flexible Spending Account/Health Reimbursement Account
403(b) Plan
Corporate Counseling Associates (CCA) EAP benefit
Ability Assist Counseling Services (through The Hartford)
Commuter Benefits
Educational Assistance Programs
Special shopping discounts through ADP Marketplace and PlumBenefits
RUFit?! Fitness Program
Legal Assistance through ARAG
Optum Financial Service through ConnectYourCare
Benefit Advocacy Center through Gallagher
MAJOR FUNCTION:
The 820 Billing Assistant is responsible for assisting billing team with collection of Managed Care Organization payments.
SPECIFIC DUTIES & RESPONSIBILITIES:
Reconcile client number of days stay between AWARDS and Census Reports
Verify accuracy of clients' health insurance in AWARDS through ePaces
Access real-time payer portals to verify accuracy in authorization ID entered in AWARDS
Verify and confirm appropriate diagnosis and procedure coding as per clinical documentation
Navigate payee websites/portals to keep track payments or denials
Works closely with co-workers to analyze and identify issues
Calling insurance companies to research the reason for denials
Post payments in AWARDS database
REQUIREMENTS:
Excellent analytical, problem solving, and interpersonal and communication skills
Proficiency in Microsoft Excel
Must be able to work independently and with a team
Odyssey House is an equal opportunity employer maintaining a non-discriminatory policy on hiring of its personnel. Odyssey House, and its operational divisions, will not discriminate against any employee or applicant because of race, creed, color, national origin, sex, disability, marital status, sexual orientation or citizen status in all employment decisions including but not limited to recruitment, hiring, upgrading, demotion, downgrading, transfer, training, rate of pay or other forms of compensation, layoff, termination and all other terms and conditions of employment.
$32k-39k yearly est. 20d ago
Billing Specialist
CN Guidance and Counseling Services 3.5
Hicksville, NY jobs
If you're detail-oriented and experienced in the medical billing field, then CN Guidance and Counseling Services has the perfect career opportunity for you! We're hiring a full-time BillingSpecialist to oversee medical accounts receivable matters and coordinate with insurance companies regarding claims.
This is a remote role, and you'll be making $21.98 - $25.50/hour (based on experience). We also offer exceptional benefits and perks, including:
$0 deductible platinum plus medical insurance plan (90% employer-provided benefit)
Dental and vision
FSA/HRA
403(b) retirement plan
Long- and short-term disability
Legal plan and a dependent care expense account
Provided and supplemental life insurance
Pet insurance
Training and mentorship programs
5 Personal Days, 10-20 Vacation Days, 12 Sick Days, 12 Company Paid Holidays-yearly and so much more
Potential for student loan forgiveness
Discounts to Broadway shows and more amazing employee perks!
YOUR SCHEDULE
Our Healthcare BillingSpecialist works 9:00 am to 5:00 pm, Monday through Friday and is remote.
As our BillingSpecialist, you'll be communicating with patients, coworkers, and insurance companies to ensure our records are accurate and accounts receivable matters are properly handled. You'll review various documentation (referrals, patient records, EOBs, etc.) to verify accuracy. Prepare and submit accounts receivable data, contact insurance companies about unpaid claims, and follow up on aging reports. When a company denies a claim, you'll investigate the cause, appeal the decision when appropriate, identify patterns in denials, and adjust strategies to minimize future denials. You'll follow all safety protocols, attend on-site functions, and foster an inclusive culture where every team member feels empowered to grow and thrive!
Education and Experience Required
2+ years of experience performing accounts receivable follow-up in a healthcare setting
Strong understanding of billing concepts, ICD-10, medical terminology, behavioral health billing, and electronic medical records
Ability to read and understand EOBs
Ability to complete QI training and participate in refresher training
Proficiency with Microsoft Office, specifically Excel and Word
Excellent time management and multitasking skills
Excellent verbal and written communication skills
Suitable remote workspace
OUR STORY
Since 1972, CN Guidance and Counseling Services has been committed to improving the quality of life for individuals and families on Long Island affected by mental health and substance use disorders. Our mission is to integrate mental and physical health services to support our community's overall well-being. Recognized as a top Long Island workplace for five consecutive years, we pride ourselves on our inclusive culture that fosters growth, collaboration, and innovation. Every team member plays a crucial role in helping others lead healthy and fulfilling lives.
If you see yourself excelling as our BillingSpecialist, apply now by completing our short initial form!
$22-25.5 hourly 40d ago
Billing Follow-Up Representative
Ambulnz 3.9
New York jobs
Title: Billing Follow-Up Representative
Employment Type: Full time
Pay Rate: $19 - $24 per hour
Benefits: Medical, Dental, and Vision (with company contribution), Paid Time Off, 401k
About DocGo
DocGo is leading the proactive healthcare revolution with an innovative care delivery platform that includes mobile health services, population health, remote patient monitoring, and ambulance services. DocGo disrupts the traditional four-wall healthcare system by providing high quality, highly affordable care to patients where and when they need it. DocGo's proprietary, AI-powered technology, logistics network, and dedicated field staff of over 5,000 certified health professionals elevate the quality of patient care and drive efficiencies for municipalities, hospital networks, and health insurance providers. With Mobile Health, DocGo empowers the full promise and potential of telehealth by facilitating healthcare treatment, in tandem with a remote physician, in the comfort of a patient's home or workplace. Together with DocGo's integrated Ambulnz medical transport services, DocGo is bridging the gap between physical and virtual care.
Responsibilities:
Contact payers to verify claim status via phone or web and follow up on unpaid claims.
Process appeals on aged insurance claims/denials.
Ability to analyze, identify and resolve issues which may cause payer payment delays.
Identify and resolve claim edits through understanding of billing guidelines and payer requirements.
Reconcile commercial and government accounts, ensuring CPT and diagnostic codes are accurate.
Interpret terms for Managed Care, Commercial, Medicare, Medicaid when applicable.
Review all EOBs for correct payment, deductible, adjustments, and denials.
Determining the status of claims with the insurance company, if the claim meets contractual agreements or needs adjustment.
Reconcile account balances, and verify payments are applied correctly.
Maintain well aged accounts, promptly resolve and resubmit denied unpaid claims in a timely and efficient manner.
Follow up on appeals/corrected submitted claims.
Review and correct billing errors, which require a strong knowledge of CPT and ICD-10 coding.
Review and audit customer service account inquiries.
Receive inbound/outbound customer service calls,
provide excellent customer service to all patients, Insurances & Facilities.
Review and correct all rejections in clearing house.
Follow-up with Self-Pay patients to resolve any account issues that may exist
Other duties as assigned
Requirements:
Minimum of 2-3 years billing follow-up experience with a high-volume practice or clinic, ambulance experience preferred.
Excellent organizational skills and the ability to multitask in a fast-paced environment.
Analytical - collects and researches data; uses intuition and experience to complement data.
Excellent Follow-up skills including appeals/reconsiderations.
Familiarity with Microsoft Office Suite.
Working knowledge of AthenaOne.
EEO/AAP Statement: DocGo is an equal opportunity employer. We acknowledge and honor the fundamental value and dignity of all individuals. We pledge ourselves to crafting and maintaining an environment that respects diverse traditions, heritages, and experiences. DocGo is an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.
The above-noted job description is not intended to describe, in detail, the multitude of tasks that may be assigned but rather to give the applicant a general sense of the responsibilities and expectations of this position. As the nature of business demands change so, too, may the essential functions of the position.
$19-24 hourly Auto-Apply 13d ago
Billing Specialist
Tal Healthcare 3.8
White Plains, NY jobs
Our client, a leading provider of behavioral health and substance use disorder services, is hiring a
BillingSpecialist
to ensure accurate and efficient management of billing, eligibility verification, and claims processing. This key role supports clinical operations by verifying client benefits, coordinating pre-authorization requirements, and assisting with financial counseling to optimize patient care and revenue cycle workflows.
Responsibilities:
Determine initial client eligibility and benefits, including pre-authorization or pre-certification requirements under benefit plans for substance use disorder services.
Input authorization tracking data into Insync and notify clinical leadership of pre-auth or admission needs before client appointments.
Prepare and distribute financial agreements, ensuring clients understand their financial responsibility; meet with eligible clients for financial counseling and sliding scale agreements.
Review daily eligibility batch reports, contacting ineligible clients to update insurance information, facilitate recertification, or manage out-of-pocket payments.
Confirm appointment eligibility prior to service, notify front desk staff and clients of any ineligibility, and ensure appropriate documentation.
Verify provider billing codes, review service charges for accuracy, and correct any coding issues promptly.
Monitor billing submissions, ensuring services are billed within 48 hours of delivery, and address denied or unpaid claims through coordination with billing software and clinical staff.
Generate and analyze billing and accounts receivable reports, assist with collections, and maintain accurate financial records.
Support clinical and administrative staff with billing or insurance-related inquiries and serve as a resource for billing best practices.
Manage the assessment tracker to monitor appointment no-shows, cancellations, and rescheduling activities.
Requirements:
Associate's degree or higher in health administration, medical billing, or related field.
Minimum of 2 years' experience in healthcare billing and eligibility verification.
Proven experience in medical or behavioral health billing and coding, with familiarity in insurance verification and claims processing.
Strong knowledge of billing software, particularly Insync, and proficiency with Medicaid, insurance benefits, and pre-authorization procedures.
Excellent organizational skills with the ability to multitask and prioritize in a fast-paced environment.
Effective communication skills to liaise with clients, clinical staff, and insurance providers.
Attention to detail and accuracy in reviewing charges, coding, and documentation.
Ability to work on-site, with availability to coordinate with clinical and administrative teams.
Familiarity with confidentiality regulations and compliance standards related to healthcare information.
Nice to Have Skills:
Experience working with Medicaid and other government-funded programs.
Basic understanding of behavioral health services and clinical workflows.
Certification in medical billing or coding (e.g., CPC, CPRS).
Bilingual abilities to serve diverse patient populations.
If you are meticulous, customer-focused, and eager to contribute to a mission-driven organization, we encourage you to apply today. Join a dedicated team committed to improving lives through outstanding administrative and clinical collaboration.
Salary: The posted range is not a guarantee. The actual salary will be based on qualifications, experience, and education and could fall outside of this range. Contact us for more information.
#LI-FP1
$38k-54k yearly est. 6d ago
Entitlement Medicaid Specialist
Odyssey House Inc. 4.1
New York, NY jobs
TITLE: Entitlement Medicaid Specialist (FT)
REPORTS TO: Director of Entitlements
Our Mission:
Since 1967, Odyssey House has been providing innovative services and programs to a broad population of individuals and families struggling with substance use and mental health disorders. Odyssey House helps New Yorkers of all ages-and across all five boroughs-beat drugs and alcohol with highly individualized treatment programs. Odyssey House provides high quality, holistic treatment impacting all major life spheres, including: psychological, physical, social, family, educational and spiritual in order to support personal rehabilitation, renewal and family restoration.
If that sounds different than other treatment programs, you're right. Because Odyssey is where recovery gets real.
In addition to competitive salaries, Odyssey House offers:
A 35-hour work week (as opposed to a 40-hour work week)
Vacation Plan and Holiday Schedule
Life Insurance
Medical Insurance (Two Plans)
Dental and Vision Insurance
Additional Insurance Coverages (hospitalization, accidental, critical illness coverage)
Long-Term & Short-Term Disability
Flexible Spending Account/Health Reimbursement Account
403(b) Plan
Corporate Counseling Associates (CCA) EAP benefit
Ability Assist Counseling Services (through The Hartford)
Commuter Benefits
Educational Assistance Programs
Special shopping discounts through ADP Marketplace and PlumBenefits
RUFit?! Fitness Program
Legal Assistance through ARAG
Optum Financial Service through ConnectYourCare
Benefit Advocacy Center through Gallagher
MAJOR FUNCTIONS:
Maintain a working relationship with the Department of Social Service (DSS), Human Resources Administration (HRA), the Social Security Administration (SSA), Medicaid Office, Expedited and Marketplace to ensure Medicaid Managed Care guidelines, policies and procedures are followed to receive appropriate funding for 819 and 820 programs.
SPECIFIC DUTIES & RESPONSIBILITIES:
Conduct daily comprehensive review of consumers' interviews to determine eligible for Entitlements benefits, Medicaid Eligibility, Medicaid Managed Care, Medicare, Private Insurance coverage, Self-Pay
Case conference difficult cases with the Director for guidance and support to ensure funding for 819 and Part 820 programs are obtained in a timely fashion
Conduct interviews on new admissions for HRA/DSS/Medicaid/SSI/SSD/Self-Pay
Expedite consumers with the selection of Managed Care Organization, assist with the NY State Market Place at point of admissions and upon Medicaid Eligibility
Daily Data Entry of Medicaid Managed Care coverage / Medicare / Private Insurance / MAT in AWARDS, E-Lab and LabCorp Portal
Daily update the Entitlement 820 Reports with consumers' coverage
Navigate Epaces (eMedNY) / Inovalon / STARS / SAAMS / AWARDS / WTW / Manage Care System Portals for coverage
Communicate with consumers regarding insurance coverage, restrictions, and disenrollment (Medicaid/Managed Care, Medicare, and Private Insurance)
Process Medicaid applications and recertifications for consumers through the Department of Social Services, NY State Exchange/Marketplace
Investigate Medicaid disparities related to county / deferral / eligibility / denial / dropped / recertification
Identify and process consumers with Medical / Pharmacy / Out-Patient restrictions through the Managed Care Organization and Managed Care System (MCS)
Resolve problematic Medicaid Managed Care issues for Part 820 coverage
Complete and submit bi-weekly 820 Medicaid Managed Care Reports
Complete weekly Medicaid Manage Care Reports for five residential programs to reflect consumers' coverage for the Pharmacy, Medical department and LabCorp
Other relevant duties as assigned
REQUIREMENTS:
BA Degree preferred
Experience with Medicaid Managed Care; Human Services Field
Background with DSS/HRA benefits, Recertifications, Medicaid Managed Care, Expediting, enrollment and disenrollment
Demonstrated effective communication, proficiency in Excel, computer skills, organization and multitasking
Notary Public Stamp
Odyssey House is an equal opportunity employer maintaining a non-discriminatory policy on hiring of its personnel. Odyssey House, and its operational divisions, will not discriminate against any employee or applicant because of race, creed, color, national origin, sex, disability, marital status, sexual orientation or citizen status in all employment decisions including but not limited to recruitment, hiring, upgrading, demotion, downgrading, transfer, training, rate of pay or other forms of compensation, layoff, termination and all other terms and conditions of employment.
$32k-45k yearly est. Auto-Apply 2d ago
Medicaid Specialist
Odyssey House Inc. 4.1
New York, NY jobs
TITLE: Medicaid Specialist
REPORTS TO: Director of Entitlements
DEPARTMENT: Entitlements - 219 East 121st St. New York, NY 10035
Our Mission:
Since 1967, Odyssey House has been providing innovative services and programs to a broad population of individuals and families struggling with substance use and mental health disorders. Odyssey House helps New Yorkers of all ages-and across all five boroughs-beat drugs and alcohol with highly individualized treatment programs. Odyssey House provides high quality, holistic treatment impacting all major life spheres, including: psychological, physical, social, family, educational and spiritual in order to support personal rehabilitation, renewal and family restoration.
If that sounds different than other treatment programs, you're right. Because Odyssey is where recovery gets real.
In addition to competitive salaries, Odyssey House offers:
A 35-hour work week (as opposed to a 40-hour work week)
Vacation Plan and Holiday Schedule
Life Insurance
Medical Insurance (Two Plans)
Dental and Vision Insurance
Additional Insurance Coverages (hospitalization, accidental, critical illness coverage)
Long-Term & Short-Term Disability
Flexible Spending Account/Health Reimbursement Account
403(b) Plan
Corporate Counseling Associates (CCA) EAP benefit
Ability Assist Counseling Services (through The Hartford)
Commuter Benefits
Educational Assistance Programs
Special shopping discounts through ADP Marketplace and PlumBenefits
RUFit?! Fitness Program
Legal Assistance through ARAG
Optum Financial Service through ConnectYourCare
Benefit Advocacy Center through Gallagher
MAJOR FUNCTIONS:
Maintain a working relationship with the Department of Social Services/Medicaid Office/Expedited and Marketplace to ensure Medicaid Managed Care guidelines and policies and procedures are follow.
SPECIFIC DUTIES & RESPONSIBILITIES:
• Conduct a comprehensive review to determine eligibility for Medicaid and Managed Care for the 820 Programs
• Daily Review of consumers' insurance verification and Medicaid Managed Care coverage
• Communicate with consumers regarding insurance coverage, restrictions, and disenrollment (Medicaid/Managed Care, and Medicare)
• Process Medicaid applications and recertifications for potential consumers through the Local Department of Social Services or the NY State Exchange/Marketplace
• Investigate Medicaid issues related to eligibility, deferrals, denials and recertifications
• Identify consumers with Medical and Pharmacy restrictions to complete MAP forms to the removal of restrictions
• Process restrictions through the Managed Care System (MCS), Office of the Medicaid Inspector General (OMIG)
• Resolve problematic Medicaid Managed Care and Department of Social Services issues
• Navigate eMedNY (ePACES) / Managed Care Portals / Inovalon / STARS / AWARDS
• Daily Data Entry of Medicaid Managed Care / Medicare / Private Insurance / MAT in AWARDS and E-Lab
• Prepare weekly status of consumers' Medicaid Managed Care / Medicare / Private Insurance status and Expedite consumers with straight Medicaid coverage
• Review weekly consumers' Medicaid Managed Care coverage and dropped coverage
• Prepare biweekly Medicaid Manage Care Reports to reflect current coverage
• Assist consumers with the selection of Managed Care and NY State Market Place
• Performs related or similar duties assigned by Director.
REQUIREMENTS:
• Associate/BA Degree preferred
• Experience with Medicaid and Managed Care and in Human Service Field
• Minimum 2 years of experience in Medicaid, managed care plans, application process, recertifications and regulations
• Demonstrated effective communication, proficient with Excel, computer skills, organization and multitasking
Odyssey House is an equal opportunity employer maintaining a non-discriminatory policy on hiring of its personnel. Odyssey House, and its operational divisions, will not discriminate against any employee or applicant because of race, creed, color, national origin, sex, disability, marital status, sexual orientation or citizen status in all employment decisions including but not limited to recruitment, hiring, upgrading, demotion, downgrading, transfer, training, rate of pay or other forms of compensation, layoff, termination and all other terms and conditions of employment.
Dent Neurologic Institute is committed to excellence in all we do. Our culture is built on 4 key pillars: respect, quality, productivity, and well-being. By remaining dedicated to these values and the overall mission, we are dedicated to making a difference for both patients and colleagues. When you join the Dent team, you can take advantage of a variety of benefits:
Work-Life Balance (no overnight shifts)
Medical, Dental & Vision Plans
Life Insurance
401(k) Retirement Plan
Critical Illness, Accident, & Legal Plans
Wellness Program
Learning & Development Opportunities
Paid Time Off
Paid Holidays
Free Onsite Parking at All Locations
Working Schedule: Full-time, Monday - Friday, 8:30 am to 5:00 pm
Location: Amherst
Position Summary: Under direct supervision, is responsible for initiating and coordinating all functions related to submitting and collecting on medical claims. This includes charge entry, payment posting, claims appeals, cash management and collections.
Responsibilities of Position:
Answer all phone calls in an effort to assist patients with billing questions
Sort mail appropriately
Demonstrates the ability to accept responsibility for appropriate conduct within the office setting and with other department associates by interacting calmly, respectfully and in a friendly manner with other representatives of services at Dent.
Maintains strict confidentiality of patient information.
Completes clerical duties in a time efficient manner as set forth by the Team Leader. Reports errors or problems so that appropriate action may be taken for patient care.
Performs other duties as assigned or requested
In addition, all staff will be responsible for one or more of the following:
Prepares all payments for posting
Enters all deposits and checks into appropriate spreadsheet.
A/R Follow-up:
Works denials from all insurances for assigned physicians.
Works accounts receivable for unpaid claims for assigned physicians.
Follows up on insurance inquiries to ensure payment is received.
Works Workers Comp and No Fault denials.
Works accounts receivable for unpaid Comp and No Fault claims.
Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
Skills & Experience Necessary:
Strong general office skills, including typing skills
Strong planning, problem solving and organizational skills
Working knowledge of Microsoft windows programs including Excel and Word
Working knowledge of general office equipment including multi-line phone, computer, copier, calculator, and fax machines
Effective communication and interpersonal skills
Medical Terminology
Required Education
High school diploma and 2-4 years of related experience
Preferred Education:
· Associates Degree in Medical Billing and Reimbursement with a minimum of 1 years of Medical Billing experience
Previous experience in medical practice setting
Experience with ICD-10 and CPT coding
Knowledgeable in collection process
Working Conditions:
Normal working environment, typical of most office settings
Minimal physical effort, requires some lifting of files, usually not in excess of 15 pounds.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions
Compensation:
Most candidates will start within the first quartile of the pay range
Rates are commensurate with experience
EEO Statement
Dent Neurologic Institute offers an inclusive work environment built on kindness and respect for all. Dent provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws as the basis for an employment decision. All qualified individuals are encouraged to apply and will receive consideration.
Dent Neurologic Institute is committed to excellence in all we do. Our culture is built on 4 key pillars: respect, quality, productivity, and well-being. By remaining dedicated to these values and the overall mission, we are dedicated to making a difference for both patients and colleagues. When you join the Dent team, you can take advantage of a variety of benefits:
Work-Life Balance (no overnight shifts)
Medical, Dental & Vision Plans
Life Insurance
401(k) Retirement Plan
Critical Illness, Accident, & Legal Plans
Wellness Program
Learning & Development Opportunities
Paid Time Off
Paid Holidays
Free Onsite Parking at All Locations
Working Schedule: Full-time, Monday - Friday, 8:30 am to 5:00 pm
Location: Amherst
Position Summary: Under direct supervision, is responsible for initiating and coordinating all functions related to submitting and collecting on medical claims. This includes charge entry, payment posting, claims appeals, cash management and collections.
Responsibilities of Position:
Answer all phone calls in an effort to assist patients with billing questions
Sort mail appropriately
Demonstrates the ability to accept responsibility for appropriate conduct within the office setting and with other department associates by interacting calmly, respectfully and in a friendly manner with other representatives of services at Dent.
Maintains strict confidentiality of patient information.
Completes clerical duties in a time efficient manner as set forth by the Team Leader. Reports errors or problems so that appropriate action may be taken for patient care.
Performs other duties as assigned or requested
In addition, all staff will be responsible for one or more of the following:
Prepares all payments for posting
Enters all deposits and checks into appropriate spreadsheet.
A/R Follow-up:
Works denials from all insurances for assigned physicians.
Works accounts receivable for unpaid claims for assigned physicians.
Follows up on insurance inquiries to ensure payment is received.
Works Workers Comp and No Fault denials.
Works accounts receivable for unpaid Comp and No Fault claims.
Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
Skills & Experience Necessary:
Strong general office skills, including typing skills
Strong planning, problem solving and organizational skills
Working knowledge of Microsoft windows programs including Excel and Word
Working knowledge of general office equipment including multi-line phone, computer, copier, calculator, and fax machines
Effective communication and interpersonal skills
Medical Terminology
Required Education
High school diploma and 2-4 years of related experience
Preferred Education:
· Associates Degree in Medical Billing and Reimbursement with a minimum of 1 years of Medical Billing experience
Previous experience in medical practice setting
Experience with ICD-10 and CPT coding
Knowledgeable in collection process
Working Conditions:
Normal working environment, typical of most office settings
Minimal physical effort, requires some lifting of files, usually not in excess of 15 pounds.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions
Compensation:
Most candidates will start within the first quartile of the pay range
Rates are commensurate with experience
EEO Statement
Dent Neurologic Institute offers an inclusive work environment built on kindness and respect for all. Dent provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws as the basis for an employment decision. All qualified individuals are encouraged to apply and will receive consideration.
Mon- Fri 8:30am - 5:00pm
40 hours/week