Billing Specialist

Elmcor Youth & Adult Activities Inc; New York (NY); On-site; USD 55,000 - 63,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

401K with match

Paid time off

Sick days

Floating holidays

Gym access

Life insurance

Short-term disability

Job summary

Elmcor Youth & Adult Activities Inc. in St. Albans, NY, seeks a Billing Specialist to ensure accurate, timely processing of claims across Medicaid, Medicare, managed care, and private insurances.

The role requires verifying eligibility, submitting electronic claims through InSync and Inovalon, researching denials, and communicating with participants about balances and payment plans. A strong background in billing software and strong communication skills is essential.

Qualifications

• Bachelor’s degree or over 5 years of experience.
• Knowledge of billing software, (Preferably EPACES, Insync and Inolvalon).
• Good record keeping skills, outstanding communication skills and excellent interpersonal skills
• Must have computer skills and pass a criminal background check.

Responsibilities

• Verify participant’s eligibility for Medicaid, Medicare and private insurances.
• Process Insurance payments to participant accounts in computerized system.
• Pre certify, pre authorize, and obtain authorization for participant SUD billing.
• Submit accurate electronic claims through InSync and Inovalon.
• Research rejected/denied/unpaid claims and complete corrections and follow-up.
• Review remittance and payment info; identify underpayments and posting discrepancies.
• Explain self-pay responsibilities and payment arrangements to participants.
• Monitor self-pay balances and follow up on payment plans.
• Escalate delinquent accounts to Billing Manager and maintain trackers.

Skills

Record keeping

Communication

Interpersonal skills

Multitasking

Education

Bachelor's degree

Tools

EPACES

InSync

Inovalon

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

St. Albans, NY, US

Salary: $55,000.00 Annually

Responsible for accurate and timely billing, claim follow up, denial resolution, self-pay financial assessments, and payment follow up for Medicaid, Medicare, managed care, commercial insurances and self-pay services using InSync by Qualifacts and the Inovalon clearinghouse.

Reports to theBilling Manager

Schedule:

Monday - Friday 10AM - 6PM , Subject to change based on program need.

Responsibilities:

Core duties and responsibilities include the following. Other duties may be assigned as needed.

• Verify participant’s eligibility for Medicaid, Medicare and private insurances
• Process Insurance payments to participant accounts in computerized system.
• Make sure all participants are pre certified, pre authorized, and authorization for participant SUD billing.
• Submit accurate electronic claims through InSync and Inovalon, the agency’s clearinghouse.
• Researches rejected, denied and unpaid claims; completes corrections, resubmissions, appeals and payer follow-up through resolution.
• Reviews remittance and payment information and identifies underpayments, recoupments, missing payments and posting discrepancies
• Responds to participant billing and statement inquiries.
• Makes recommendations to management for write-offs.
• Handles appeals and follow-up for managed care and out-of-network claims.
• Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully.
• Conducts financial assessments for self-pay participants in accordance with agency policies and established fee schedules.
• Explains self-pay responsibilities, payment expectations and available payment arrangements to participants.
• Monitors self-pay balances and follows up with participants regarding outstanding payments and agreed-upon payment plans.
• Maintains accurate documentation of financial assessments, payment arrangements, and participant communication and collection activity.
• Escalates delinquent accounts and recommends appropriate next steps to the Billing Manager.
• Works assigned A/R by age and timely-filing risk; documents all billing activity and follow-up dates; maintains billing and collection trackers; escalates unresolved barriers to the Billing Manager.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience:

• Bachelor’s degree or existing staff with over 5 years of experience.
• Knowledge of billing software, (Preferably EPACES, Insync and Inolvalon)
• Good record keeping skills, outstanding communication skills and excellent interpersonal skills
• Must have computer skills.
• Must successfully complete a criminal background check, obtain clearance from the Office of Children and Family Services and be drug free.

Other Skills/Abilities:

• Researches rejected, denied and unpaid claims; completes corrections, resubmissions, appeals and payer follow-up through resolution.
• Excellent judgment and discretion; ability to handle multiple priorities simultaneously, meet deadlines, and handle work-related stress is required.
• Friendly, courteous, service-oriented, professional, outgoing, and customer service oriented.
• Detail oriented while maintaining an extremely positive attitude.
• Must be able to work independently and productively with minimum supervision.
• Recognize problems, identify possible causes and resolve routine problems.
• Team player with a "can do" attitude that can work in a fast-paced environment.
• Ability to establish and maintain professional atmosphere for employees, participants and customers

We offer a comprehensive benefits package that includes health, dental, and vision insurance, paid time off, retirement plans, and additional employee perks.

• 15 Vacation Days Annually
• 12 Sick Days
• Floating Holiday 1 annually
• 401K retirement plan with 3% match after 90 days of employment
• Medical Benefits after 30 days of employment with Cigna
• Dental/Vision eligible after 90 days of employment
• Access to Gym/Weight Room
• Access to Boxing Ring
• Short Term Disability
• Life, Accidental Insurance available through Aflac

Join Elmcor Youth & Adult Activities as a Billing Specialist and play a vital role in supporting the organization’s financial operations and ensuring accurate, timely, and compliant billing processes. In this position, you will help maintain the financial integrity of our programs by reviewing billing documentation, processing claims, resolving discrepancies, and collaborating with program and administrative teams to ensure services are properly documented and reimbursed.

Join a team where your expertise directly supports the continued success of programs that make a meaningful difference in the community.