Medical Biller
hace 10 días
Babylon
Job DescriptionSouth Shore Speech is looking for a competent, responsible and dedicated individual to join our busy/fast paced, award winning team 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. PreAuthorizations & 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 & ThirdParty 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 (NYEI), • 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 Yorks EI system, including eligibility updates and end-of-year reauthorizations.4. CPSE (PreSchool 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. IUITP)., • 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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