Managed Care Billing Specialist*

The Finance Department in Waters Place, Bronx is seeking a full time Managed Care Billing Specialist to join our team. 

The Managed Care Specialist is responsible for resolving Managed Care denied and underpaid claims timely.

Responsibilities

• Must be able to understand Managed Care contracts, create project spreadsheets for submission to payers, write reconsideration appeals and send to MCOs, and be able to communicate both internally and externally for resolution of claim disputes.
• Collaborate with all MCO payers to resolve payment errors and underpayments.
• Submit monthly excel reports and written appeals letters to resolve external underpayments in a timely fashion.
• Track MCO responses
• Complete understanding of billing system (Netsmart/ MyUnity) is needed to identify payment discrepancies, monitor and track performance of recoveries, meet goals, audit claim payments, and identify other issues affecting AR.
• Work closely with Revenue Cycle Director and Director and resolve issues as they arise.
• Other duties as assigned by Director of Revenue Cycle

Qualifications

Knowledge, Skills and Abilities Required:

• Minimum 5 years’ experience in health insurance, skilled nursing home billing is required
• Must Understand Medicare, Managed Care, Medicaid (NY) billing and reimbursement
• Prior experience working with Managed Care claims and appeals processes for skilled nursing home is required
• Must have fluency working with billing system
• Understanding of EOBs, remittance advice
• Full understanding of Managed Care contracts and payment methodologies
• Strong skills with Excel, Patient Accounting systems and Provider Portals
•  Strong communication skills and ability to de-escalate conversations to achieve organizational goals
• Ability to work independently, meet deadlines, troubleshoot, and present findings
• Must be detail-oriented with strong critical thinking and organization skills

Education

• Bachelor's Degree in a related field

Specialized Skills and Competencies:

• Work requires an extensive knowledge of business and an excellent command of the English language, both written and verbal.
• Must have knowledge of office administrative procedures, and familiarity with the use and operation of standard office equipment, at a level generally acquired through 5+ years of related experience.
• Must have knowledge of a variety of computer software applications in word processing, spreadsheets, database and presentation software including Word, PowerPoint, Excel and other programs as needed.
• Must have high level of interpersonal skills to handle sensitive and confidential situations. Position continually requires demonstrated poise, tact and diplomacy.
• Some analytical ability is required in order to gather and summarize data for reports, find solutions to various administrative problems, and prioritize work.
• Work requires continual attention to detail in composing, typing and proofing materials, establishing priorities and meeting deadlines.
• Ability to plan and conduct duties in accordance with age appropriate capabilities and needs of the elderly and adult population.

Job Qualifications:

1. Bachelor’s Degree required for new hires.
2. 3 – 5 Years related experience
3. Keyboard skill – 50 – 55 WPM
4. Board minutes writing experience.

Physical Demands: 

Able to sit for long periods of time at the computer.  Walking, sitting, standing or lifting while in the office environment limited to files and records not expected to exceed ten (10) pounds in weight.