Billing Specialist
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Job Location:
New York City, NY - USA
Monthly Salary:
Not Disclosed
Posted on:
30+ days ago
Vacancies:
1 Vacancy
Job Summary
As a billing specialist you will ensure claims are submitted promptly and accurately to the appropriate payer with the majority of these being Medicaid Managed Care Organizations (MCOs). The billing specialist will liaise with Mae Healths program managers and health plan Electronic Data Interchange (EDI) / billing points-of-contact to identify and troubleshoot issues with claims submission and/or payment.
Key Responsibilities Include:
Claims Review and Processing:
Review claims prior to submission for coding accuracy appropriate rate assignments and completeness to ensure high standards of clean claim submissions utilizing Candid Healths RCM (Candid) platform
Timely reviewing processing and submission of claims tracking claims throughout their life cycle from pre-submission review to final provider payout.
Monitors claim statuses and follows up on all claims not processed within Maes Service Level Agreements (SLAs) for timely claims processing
Managing Rejections Denials and Appeals:
Resolves claim errors and/or discrepancies and expediently communicates any issues to plan EDI point-of-contact and relevant Mae personnel
Resolves disputed claims by consulting with appropriate internal and external stakeholders
Payment Timeliness and Adherence to Maes Service Level Agreements (SLAs):
Monitors and tracks claim payments in Candid and flag for provider direct-payment accordingly
Monitor and process payments Maes database for claims in queue for Priority Payout based on SLA requirements for timely payment
Cross-Functional Reporting and Stakeholder Collaboration:
Preparing reports for Maes Executive Leadership Team on claims trends performance against SLAs and identifying issues or concerns with claims adjudication that require further escalation
Provide direct provider support for billing-specific inquiries received via Maes customer support database
Providing timely and accurate responses to health plans EDI points-of-contact for ongoing claims adjudication issues
Compliance and Documentation:
Meticulous record-keeping of claim submissions status and pertinent notes to keep internal stakeholders informed
Stays up-to-date on information required for claims submission and remittance and associated contracted rates including oversight and maintenance of Maes Billing Codebook in collaboration with program managers and VP of Partner Success
Other billing assignments within skills and abilities:
Providing technical assistance and ongoing training support to fellow team members
Supporting Mae product team in insights to enhance product including automation of manual claims processing tasks
Qualifications :
What we are looking for in candidates:
Strong understanding of healthcare billing coding and claims-management processes
Experience with revenue cycle management platforms required; experience with Candid Health strongly preferred
Dynamic solution-oriented and collaborative individuals
Strong organizational skills and ability to manage multiple workstreams in a fast-paced environment
Exceptional attention to detail and accuracy in managing member and financial data
Strong analytical skills and ability to recognize trends and identify inefficiencies
Strong written and verbal communication and interpersonal skills for Mae executive leadership team service providers and payer interactions
3 to 5 or more years of previous Medicaid billing experience
Additional Information :
Position type: 1099 contract-to-hire
Contract length: 6 months
Working hours: Monday - Friday 9 AM - 5 PM (ET)
Compensation: $58000 to $62500 depending on experience
Flexible U.S. work location
All your information will be kept confidential according to EEO guidelines.
We are currently only hiring US based applicants and are unable to sponsor visas.
Mae Health Participates in E-Verify
This employer participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. If E-Verify cannot confirm that you are authorized to work this employer is required to give you written instructions and an opportunity to contact Department of Homeland Security (DHS) or Social Security Administration (SSA) so you can begin to resolve the issue before the employer can take any action against you including terminating your employment. Employers can only use E-Verify once you have accepted a job offer and completed the Form I-9.
Remote Work :
Yes
Employment Type :
Contract
Key Skills
- Medical Collection
- Accounts Receivable
- Athenahealth
- ICD-10
- Medical Coding
- 10 Key Calculator
- Detailing
- ICD-9
- Medical Billing
- Microsoft Excel
- CPT Coding
- Medicare
About Company
MEET MAEMae is a venture-backed digital health solution on a mission to improve the health and quality of life for mothers, babies, and those who love them. Mae has created a space where complete digital care meets culturally-competent on-the-ground support. We address access gaps and ... View more
