Offer: Billing Specialist

Billing Specialist

Sun River Health provides the highest quality of comprehensive primary, preventative and behavioral health services to all who seek it, regardless of insurance status and capability to pay, especially for the underserved and vulnerable. Sun River Health is a Federally Qualified, Non-Profit Health Center serving communities in Suffolk, Rockland, Orange, Dutchess, Ulster, Sullivan, Columbia and Westchester County. Sun River Health is currently seeking a full-time remote Billing Specialist for our Health Home-External department in support of Skyward Health, an affiliate of Sun River Health.
Billing Specialists provides billing and fiscal support to the Health Home department inclusive of monitoring member and contractor transactions, superviseing statement generation, payments, follow-up and Account Receivable reconciliation with payers. Will interface with other support contractors as necessary (i.e. external finance department and EHR vendor). There is also limited data processing support to the Health Home department.
Essential tasks and Responsibilities for a Billing Specialist:

»Transmit data to outside parties (Payors, vendors, contractors, etc.) as necessary through secure communication methods to ensure HIPAA confidentiality is maintained.

»Reconcile generated claims vs potential claims and other payment, denial and outstanding claim information

»All documentation created and/or transmitted is as correct as reasonably possible

»Monitor the status of claims in the EHR, acting on posted claims decisions from payers (or lack of responses from payers) as appropriate

»Access, as needed, state policies, insurance portals, clearinghouses, etc. to review EOBs or other documents to assist in claims reconciliation

»Handle all billing inquiries from internal and external parties, inclusive of rate changes, policy changes and HCBS & HHSC specific billing matters

»Consult on member insurance eligibility as needed

»Identify and correct rejected claims, using all needed platforms for information

»Consult-on/create/review and act on billing reports such as an Aging Accounts Receivable, Billing by CMA, MCO Payment Summary, etc.

»Resolve all billing issues and disputes by contacting insurance companies directly and, as a secondary action, involving and holding-accountable the EHR vendor as needed

»Perform scheduled data management/updating activities on a regular basis

»Reconcile MAPP tracking errors (as related to billing/documentation)

»Facilitate CMA Tracking/Billing Support Programs as created

»Attend all MCO meetings, bringing up high-level billing concerns as needed and relaying non-billing information to manager

»Create and/or deliver billing updates to the CMA/Contractor network as needed, usually through Webinars or Newsletters.

»All other responsibilities as assigned.
Skyward Health is a designated NYS Health Home that provides oversight to over 60 Care Management Agencies in Long Island, NYC and the Hudson Valley. Health Homes are responsible for billing, quality oversight, compliance, technical assistance, etc. for the agencies that work with our members to overcome health, social and financial challenges. Our mission is to improve lives and drive value.
Minimum Education Requirement: High School Diploma/GED
Minimum Work Related practice: Minimum 2-4 years
Hourly Range: $18.00 - $22.00 per hour