Billing and Claims Specialist

Cardinal McCloskey Community Services; Town of Mount Pleasant (NY); On-site; USD 52,000 - 76,000; Full time

Benefits offered by this job

Medical, Dental & Vision Insurance

403(b) Retirement Plan

Generous Paid Time Off

Flexible Work Schedules

Job summary

Cardinal McCloskey Community Services in New York seeks a meticulous Billing and Claims Specialist to manage the full lifecycle of claims across multiple programs, ensuring timely reimbursement and compliance with state, federal, and contract requirements.

You will work with clinical, administrative, and finance teams to maximize revenue, maintain accurate documentation, and support program effectiveness through precise posting and reconciliation of payments.

Qualifications

• Bachelor's degree preferred.
• Experience with EHR and billing systems.
• Thorough understanding of medical claims billing, AR management, and reimbursement processes.
• Experience billing OMH-licensed Article 31 clinics, Article 29-I services, CFTSS programs, and/or OPWDD-funded services.
• Experience preparing/submitting NYC/NYS contract or grant-funded invoices is a plus.
• Knowledge of Medicaid, Medicaid Managed Care, Medicare, commercial insurance, and government-funded billing requirements.

Responsibilities

• Prepare, review, and submit claims for Article 31, Article 29-I, CFTSS, and OPWDD-funded services.
• Prepare and submit basic contract/program invoices per funding source requirements.
• Verify patient eligibility, insurance coverage, authorizations, referrals, and service documentation before submission.
• Ensure compliance with Medicaid, Medicare, and contractual requirements.
• Review billing edits, claim rejections, and payer denials; take corrective action for timely reimbursement.
• Post payments, adjustments, refunds, and remittances; reconcile billing records.

Skills

Billing & claims processing

Accounts receivable management

Attention to detail

Payer communications

Education

Bachelor's degree preferred

Tools

Electronic Health Record (EHR) systems

Billing software

Job description

Join a Team Where Your Work Truly Makes a Difference!

Safe Children, Stable Families, Successful Lives.

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.

We are 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 a diverse range of agency programs. In this role, you will help ensure timely and accurate reimbursement for behavioral health, healthcare, children's services, and developmental disability programs while maintaining compliance with state, federal, insurance, and contract requirements.

The ideal candidate is organized, proactive, and committed to excellence. Working closely with program, clinical, administrative, and finance teams, you will help maximize revenue, support financial sustainability, and ensure services are accurately documented and billed.

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:

• Bachelor's Degree preferred.
• 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.

CMCS offers:

• Medical, Dental & Vision Insurance
• 403(b) Retirement Plan
• Generous Paid Time Off
• Flexible Work Schedules

Make a Difference Every Day

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