Impress employers and recruiters.
Choose from hundreds of resume examples.

Target Resume Now

About the Role

Responsible for accurate and timely billing, claim follow up, denial resolution, self-pay financial assessments, and payment follow up for Medicaid, Medicare, managed care, commercial insurances and self-pay services using InSync by Qualifacts and the Inovalon clearinghouse. Play a vital role in supporting the organization’s financial operations and ensuring accurate, timely, and compliant billing processes. Help maintain the financial integrity of our programs by reviewing billing documentation, processing claims, resolving discrepancies, and collaborating with program and administrative teams to ensure services are properly documented and reimbursed.

Responsibilities

Verify participant’s eligibility for Medicaid, Medicare and private insurances
Process Insurance payments to participant accounts in computerized system.
Make sure all participants are pre certified, pre authorized, and authorization for participant SUD billing.
Submit accurate electronic claims through InSync and Inovalon, the agency’s clearinghouse.
Researches rejected, denied and unpaid claims; completes corrections, resubmissions, appeals and payer follow-up through resolution.
Reviews remittance and payment information and identifies underpayments, recoupments, missing payments and posting discrepancies
Responds to participant billing and statement inquiries.
Makes recommendations to management for write-offs.
Handles appeals and follow-up for managed care and out-of-network claims.
Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully.
Conducts financial assessments for self-pay participants in accordance with agency policies and established fee schedules.
Explains self-pay responsibilities, payment expectations and available payment arrangements to participants.
Monitors self-pay balances and follows up with participants regarding outstanding payments and agreed-upon payment plans.
Maintains accurate documentation of financial assessments, payment arrangements, and participant communication and collection activity.
Escalates delinquent accounts and recommends appropriate next steps to the Billing Manager.
Works assigned A/R by age and timely-filing risk; documents all billing activity and follow-up dates; maintains billing and collection trackers; escalates unresolved barriers to the Billing Manager.

Requirements

Must successfully complete a criminal background check, obtain clearance from the Office of Children and Family Services and be found drug free.
Researches rejected, denied and unpaid claims; completes corrections, resubmissions, appeals and payer follow-up through resolution.
Excellent judgment and discretion; ability to handle multiple priorities simultaneously, meet deadlines, and handle work-related stress is required.
Friendly, courteous, service-oriented, professional, outgoing, and customer service oriented.
Detail oriented while maintaining an extremely positive attitude.
Must be able to work independently and productively with minimum supervision.
Recognize problems, identify possible causes and resolve routine problems.
Team player with a "can do" attitude that can work in a fast-paced environment.
Ability to establish and maintain professional atmosphere for employees, participants and customers

Skills

Knowledge of billing software, (Preferably EPACES, Insync and Inolvalon)
Attention to detail
Good record keeping skills
Outstanding communication skills
Excellent interpersonal skills
Computer skills

Location

Queens, NY

Work Type

Full-time

Experience Level

Over 5 years of experience

Education Level

Bachelor’s degree

Benefits

Health, dental, and vision insurance
Paid time off
Retirement plans
Additional employee perks
15 Vacation Days Annually
12 Sick Days
Floating Holiday 1 annually
401K retirement plan with 3% match after 90 days of employment
Medical Benefits after 30 days of employment with Cigna
Dental/Vision eligible after 90 days of employment
Access to Gym/Weight Room
Access to Boxing Ring
Short Term Disability
Life, Accidental Insurance available through Aflac
Transit Chek for commuting expenses
Legal Shield for legal services
Public Service Loan Forgiveness (PSLF) participant

About the Company

Join Elmcor Youth & Adult Activities as a Billing Specialist and play a vital role in supporting the organization’s financial operations and ensuring accurate, timely, and compliant billing processes.
If you are detail-oriented, organized, analytical, and committed to accuracy, we encourage you to apply today and take the next step toward a rewarding career with purpose.
Join a team where your expertise directly supports the continued success of programs that make a meaningful difference in the community.