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Medical Biller

Job Summary: Under the supervision of the Medical Billing Manager, the Medical Biller will be responsible for processing claims for participants in the agency’s Developmental Disabilities, Foster Care and Mental Health programs. S/he is responsible for assuring that the agency is accurately capturing client billing information and processing that information through New York State Medicaid, Medicaid Managed Care companies and other insurance companies.  The goal is to provide accurate and timely billing to maximize revenue collection.  S/he will be involved in electronic medical records activities and will assist in assuring agency compliance with state and federal regulations agencies.  Day-to-day responsibilities vary from location to location.

  • Data entry of the following services:
  • Run eligibility in third-party software to ensure the claims are going out to correct payer(s)
  • Submit claims to clearinghouse (Medicaid and Medicaid Managed Care), fix rejections as needed
  • Upload remits into software and save files in the financial drive weekly, by program
  • Work on denied claim(s) and rebill when necessary
  • Together with medical billing manger, provide billing report(s) to senior staff and enter data into Financial Edge
  • Maintain issue tracker between program and finance to ensure all corrections are made in a timely fashion
  • Scan completed data into financial drive by program with copy of claim status report(s)
  • Serve as day-to-day liaison to agency’s third party billing company
  • Retrieve monthly file from FCA program and send over to agency consultant who bills on behalf of the agency (PG software)
  • Retrieve remit(s) from eMEDNY and upload into PG software. Post to A/R and work on denials for resubmission(s)
  • Use coded data to produce and submit claims to Medicaid and insurance companies
  • Working directly with the Medicaid, insurance company, healthcare provider, and patient to get a claim processed and paid as appropriate.
  • Produce source material to agency so they can review and, if appropriate,  appeal unpaid claim(s)
  • Journal Entries
  • Cash Receipts
  • Deposit Back-up
  • Other duties as needed

 

MINIMUM QUALIFICATIONS:

  • Associate degree plus three years relevant administrative experience, including at least one year in a medical billing 
  • Strong familiarity with Medicaid and insurance web portals and knowledge with the life cycle of claim(s)
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