Administrative Review Specialist

Administrative Review Specialist Location Buffalo, NY (University area) :

JOB TITLE Administrative Review Specialist

DEPARTMENT Corporate Compliance

LOCATION Buffalo, N.Y.

DIRECT SUPERVISOR Corporate Compliance Coordinator

GENERAL This position will work as a member of the Quality Assurance/Corporate Compliance team assisting with the monitoring, adjustment and correction of claims and other claim related data.

SPECIFIC DUTIES & RESPONSIBILITIES

1. Maintain current knowledge of Medicaid Managed Care payer processes.

2. Research and follow through with requests for outstanding invoice information and corrections

3. Monitor accounts receivable follow-up, including monitoring replacement claims, resubmissions and appeals.

4. Track claims via remittance files.

5. Assist Accounting with review of claim denials working to resubmit invoices, file appeals or adjust accounts according to established policy and procedure.

6. Assist with identification of payment and denial trends.

7. Audit claims and escalate identified issues for internal workforce corrections and education.

8. Collaborate with Accounting team to verify the validity of invoices

9. Provide process improvement recommendations to enhance efficiency and effectiveness.

10. Perform timely and accurate review of database information.

11. Review monthly eligibility checks for service participants.

12. Provide quality assurance support for finance projects and initiatives.

13. Assist with investigations, assessments, and audits to assess compliance with applicable billing requirements and claims submission completion.

14. Work cooperatively with other department employees as needed to secure payments, including customer service, accounting, billing, program, and others as needed.

15. Assure accurate and timely documentation of consumer services and required paperwork in Western New York Independent Living, Inc's (WNYIL's) Electronic Consumer Record (ECR) database and assure that this task is completed within two (2) working days of the date of service.

16. Attend Agency's in-service training and staff meetings as well as any other agency related activities as required.

17. Participate in maintaining a neat, clean and safe work environment.

18. Perform other job-related duties as assigned by the supervisor.

EDUCATION & TRAINING

High school diploma or equivalent required

OR

Associate Degree

Professional and life experience may be considered in lieu of, in full or part of academic credentials.

KNOWLEDGE & EXPERIENCE (if required)

• High school diploma or equivalent requires three (3) years' office experience preferably in the Human Services field.

• Experience working with electronic claims data and billing preferred.

SKILLS & ABILITIES

• Must have intermediate level of knowledge of computers including the use of Excel spreadsheets, databases, word processing and networks.

• Perform in a professional, conscientious, and efficient manner for the purpose of ensuring a better quality of life for persons with disabilities.

WORK ENVIRONMENT Office

PHYSICAL DEMANDS OF THE JOB Sitting for extended periods of time. Occasional lifting of not more than 15 pounds.

HOURS / SHIFTS M-F 8:30 am - 5:00 pm. 37.5-40 hours per week.

CLASSIFICATION Full-time, salary, non-exempt, Support staff.

Range: $40,000-$44,000

BENEFITS Agency provided group health insurance. Vision, dental, life, supplemental insurances available. PTO and paid holiday package. 403(b) retirement with Agency match. Employee Assistance Program

Western New York Independent Living, Inc. values our employee safety and follows all recommended NYS required Infectious Disease Prevention Protocols.

Western New York Independent Living, Inc. is an Equal Opportunity Employer.

Reasonable accommodations will be made for people with disabilities.

Western New York Independent Living, Inc. is a scent-free agency.

Job Type: Full-time

Pay: $40,000.00 - $44,000.00 per year

Benefits:

• Dental insurance
• Employee assistance program
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

People with a criminal record are encouraged to apply

Work Location: In person