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About the Role
CMCS is seeking a detail-oriented and motivated Billing and Claims Specialist to manage billing, claims processing, payment posting, denial resolution, accounts receivable follow-up, collections, and invoicing for diverse agency programs. This role ensures timely and accurate reimbursement for behavioral health, healthcare, children's services, and developmental disability programs while maintaining compliance with all relevant requirements.
Responsibilities
- Prepare, review, and submit claims for Article 31 clinic services, Article 29-I services, CFTSS programs, and OPWDD-funded services, including IRA, Day Habilitation, Supported Employment, and Community Habilitation.
- Prepare and submit basic contract and program invoices in accordance with funding source requirements and established deadlines.
- Verify patient eligibility, insurance coverage, authorizations, referrals, service documentation, and demographic information prior to claim submission.
- Ensure claims and invoices are submitted in compliance with Medicaid, Medicaid Managed Care, Medicare, commercial insurance, OPWDD, OMH, OCFS, DOH, and contractual requirements.
- Review billing edits, claim rejections, and payer denials and take corrective action to ensure timely reimbursement.
- Process claim corrections, adjustments, voids, and resubmissions as necessary.
- Monitor and analyze accounts receivable and aging reports and conduct timely follow-up on unpaid, denied, or underpaid claims and invoices.
- Communicate with payers, funding sources, and program staff regarding claim status, authorization issues, reimbursement discrepancies, and outstanding receivables.
- Maintain detailed documentation of billing, collection, and follow-up activities.
- Accurately post payments, adjustments, refunds, and remittances and reconcile billing records as required.
- Maintain EHR and billing system information, including payers, plans, rates, procedure codes, and billing parameters.
- Identify billing, reimbursement, and revenue trends and communicate findings to management.
Requirements
- Experience with Electronic Health Record (EHR) and billing systems.
- Thorough understanding of medical claims billing, accounts receivable management, and reimbursement processes.
- Experience billing OMH-licensed Article 31 clinics, Article 29-I services, CFTSS programs, and/or OPWDD-funded services, including IRA, Day Habilitation, Supported Employment, and Community Habilitation.
- Experience preparing and submitting NYC/NYS contract or grant-funded invoices preferred.
- Knowledge of Medicaid, Medicaid Managed Care, Medicare, commercial insurance, and government-funded billing requirements.
Education Level
- Bachelor's Degree preferred.
Benefits
- Medical, Dental & Vision Insurance
- 403(b) Retirement Plan
- Generous Paid Time Off
- Flexible Work Schedules
About the Company
- At CMCS (Cardinal McCloskey Community Services), our mission is to protect, empower and promote independence for at-risk children and families and those with developmental disabilities through quality community based services.