Accounts Receivable, Billing, Certified Professional Coder (CPC), Co-Payments, Early Intervention, Electronic Medical Records, Financial Management, Insurance, Insurance Claims, Insurance Documentation, Medicaid, Medical Billing, Medical Office, Multitasking, Organizational Skills, Reconciliation, Reporting Skills, Student Services, Time Management, Training/Teaching
Benefits and Perks:
. Family/friendly work environment
. Supportive management and staff
. Employee appreciation events regularly
. Teaching/training will be provided
Qualifications:
. Certified Professional Coder
. Proficiency with Excel
. Motivated and possess the ability to multitask
. Past medical office experience necessary
. Strong organization skills
. Able to interact well and professionally with the public both in person and over the phone
Responsibilities:
1. Pre‑Authorizations & Verifications
- Contact payers (e.g. Medicaid, private insurances, NICU-funded programs) to verify patient eligibility and coverage before treatment begins.
- Submit pre-authorization requests for services requiring prior approval (e.g. speech therapy visits under Early Intervention or CPSE).
- Track authorizations, monitor denials, and coordinate with clinical staff to obtain additional documentation or clinical rationale when needed.
2. Insurance & Third‑Party Billing
- Prepare and submit claims to insurance carriers, including Medicaid, commercial payers, and EMR-based Early Intervention systems.
- Monitor claim status, follow up on unpaid or denied claims, and resubmit corrected or appealed claims as necessary.
- Reconcile payments, post EOBs (Explanation of Benefits) and ERA (Electronic Remittance Advice) data.
- Patient billing: handle co-pays, deductibles, and out-of-pocket balances; send statements or coordinate payment plans.
3. Early Intervention Program Billing (NY‑EI)
- Maintain understanding of NY State Early Intervention billing codes, rates, and service models (e.g. 1:1 vs. group, telepractice).
- Submit EI claims via the NYSED portal or billing platform used by Early Intervention providers.
- Coordinate with Service Coordinators and Special Instruction to ensure approvals and proper authorization.
- Address denials or adjustments typical to New York’s EI system, including eligibility updates and end-of-year reauthorizations.
4. CPSE (Pre‑School Special Education) Billing
- Handle billing through NYSED/NYCPSE mechanisms, often tied to Preschool Programs in Approved Settings (PPS or CPSE programs).
- Submit claims either directly or through school district billing systems (e.g. IU–ITP).
- Keep tabs on student eligibility, service plans (IFSP to IEP transitions), and annual authorization renewals.
- Coordinate with district CPSE liaisons and parents around covered services and parental consent.
5. Documentation, Compliance & Reporting
- Maintain accurate documentation of claims, appeal letters, rejections, and patient eligibility.
- Stay current with New York health regulations, Medicaid policies, and best practices for Early Intervention and CPSE billing.
- Generate reports (e.g. productivity, claim success rates, aging schedules, AR reports) for practice management and financial tracking.
6. Coordination & Communication
- Liaise with SLP clinicians, administrative staff, families, schools, and external coordinators (e.g. Service Coordinators, CPSE offices).
- Provide timely feedback on coverage limits, benefit exhaustion, and parental financial responsibility.
- Offer support to front-desk or intake team to collect necessary patient/payer information upfront (e.g. prior authorizations, CPSE numbers).
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