Third Party Billing Specialist

WHO WE ARE:

Community Healthcare Network (CHN) is a not-for-profit organization providing more than 65,000 New Yorkers with primary and behavioral healthcare, dental, nutrition, wellness, and needed support services.

Our network is made up of 14 federally qualified health centers throughout Brooklyn, the Bronx, Queens, and Manhattan, along with a fleet of mobile vans that bring health services to underserved people in need throughout New York City. We provide judgment-free, high-quality healthcare, without regard to race, religion, orientation, gender identity, immigration status or ability to pay. We turn no one away.

WHAT WE OFFER:

Growth and development: Access to various healthcare professionals and benefits to deepen understanding and interest in the various disciplines involved in community health programming.

Supportive Team culture: Be a part of an interdisciplinary environment where your ideas and work are valued and encouraged.

Comprehensive benefits: Including health, dental and vision insurance, retirement plans, employee assistance programming and more. 

POSITION SUMMARY

Under the direction of immediate supervisor, performs accurate weekly billing cycle functions to maintain and support third party revenue cash flow.

DUTIES AND RESPONSIBILITIES:

1. Creates claims, scrubbing of claims for each Health Center Clinic site, and carefully code and correct each claim for submission daily
2. Performs daily verification by E-paces/Health plan provider portal and update patient profile, as needed
3. Effectively communicates with Health Center Clinic staff to revolve Level 1 billing issues.
4. Accurately checks Medicaid grid for Medicaid numbers and entering on patient profile

• Weekly follow up on denied insurance claims, return mail and daily payor rejection errors
• Follow up on refund requests 
• Post allowances to write-off bad debt
• Follow up on pending FPBP Medicaid charges and enter Medicaid number for billing
• Post payments from insurance companies and patients

1. Under the direction of supervisor, performs follow-up on all claims submitted, resolves disputed claims by gathering, verifying, and providing additional information 
2. Using remittance report, return EOB’s for follow up on denied payments
3. Facilitates related services for health center patients and CHN staff as appropriate, with respect to their confidentiality and privacy
4. Performs other related duties, as assigned by supervisor

EDUCATION & EXPERIENCE required:

• Associate degree or a satisfactory equivalent combination of education, training, and/or experience
• Minimum of one (1) year of medical billing courses and/or one (1) year of experience with outpatient billing or a satisfactory equivalent, including knowledge of up-to-date CPT, ICD coding

KNOWLEDGE, SKILLS AND ABILITIES REQUIRED

• Familiarity with computerized billing applications and spreadsheets
• Manage care split claims 
• Knowledge of Federal and State reimbursement regulations
• Ability to be flexible in a structured environment
• Good interpersonal skills
• Ability to communicate easily and display a cordial manner towards individuals from a variety of socio-economic, cultural, and religious background.