Health Insurance Biller

About the position Bureau of Revenue focus on optimization of insurance billing and reimbursements for service provided to insured New Yorkers that seeks services in the article 28 Health specialty Clinics, Article 36, and other Care Management service areas provide by DOHMH to meet NYS Article 6 requirements. DOHMH remains committed to providing services for NYC uninsured and under insured residents. Reporting to the Assistant Director of Patient Billing by working alongside a team of talented health insurance billing specialist, you will perform health insurance billing activities and support functions including claim review, claim submission, follow up and collection activities. Applicants must be detailed oriented and must have a minimum of 5 years of work experience, basic knowledge CPT/ICD 10 codes and comprehensive understanding of the 10 steps in the revenue cycle.

Responsibilities

• Work closely with the assistant director to oversee billing and collection activities within the unit.
• Run and review daily billing reports for the unit, identify issues and provide feedback to the Assistant Director.
• Track and communicate updated patient demographics and insurance information with clinic teams to ensure transparency.
• Track and manage medical records requests from MCO to obtain prior authorization approvals and claim reimbursement.
• Review all claims CPT/ICD-10/HCPCS, payment modifiers in billing software to ensure accuracy following CMS and other third-party insurance guidelines.
• Monitor EDI denials in a timely manner.
• Prepare and batch claims out to third party payers for reimbursements.
• Review clearinghouse acceptance and rejection reports.
• Edit and make correction to rejected claims and re-batch to third party payers.
• Monitor aging accounts receivable reports (A/R) and provide feedback to Assistant Director of Patient Billing.
• Report industry billing trend and changes to Assistant Director of Patient Billing.

Requirements

• A master's degree from an accredited college with a specialization in business or public administration, financial management, or public health, and two years of full-time satisfactory experience in employee benefits or health insurance as a manager, research analyst, or underwriter, or in public health education. One year of such experience must have been in group benefits or group health insurance.
• A baccalaureate degree from an accredited college and three years of full-time satisfactory experience as described above.
• Education and/or experience equivalent to '1' or '2' above. Certification as a Certified Employee Benefits Specialist from the International Foundation of Employee Benefit Programs can be substituted for one year of experience. However, all candidates must have at least a baccalaureate degree and one year of experience in group benefits or group health insurance.

Nice-to-haves

• Knowledge of medical terminology, eligibility and third-party reimbursement.
• Strong writing, speaking and active listening skills.
• Working knowledge of obtaining prior approvals via managed care payer portals.
• Excellent problem solving and critical thinking skills.
• Knowledge of Health Insurance industry best practices.
• Basic knowledge of Article 28/36 New York State billing requirements.
• Working knowledge of Microsoft applications including, Teams, Excel spreadsheets, PowerPoint and basic knowledge of accounting principles.
• Ability to work independently, collaborate with others, multitasking, and a team player.

Benefits

• Loan Forgiveness: As a prospective employee of the City of New York, you may be eligible for federal/state loan forgiveness and repayment assistance programs that lessen your payments or even fully forgive your full balance.
• Premium-free health insurance plan that saves employees over $10K annually.
• Additional health, fitness, and financial benefits may be available based on the position's associated union/benefit fund.
• Public sector defined benefit pension plan with steady monthly payments in retirement.
• Tax-deferred savings program.
• Robust Worksite Wellness Program that offers resources and opportunities to keep you healthy while serving New Yorkers.
• Work From Home Policy: Depending on your position, you may be able to work up to two days during the week from home.
• Job Security: More job security compared to private sector employment.

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