Health Care Billing Specialist

Health Care Billing Specialist

Salary Grade: 22

Full time annual salary: $75,999 - $86,588

The Research Foundation for Mental Hygiene, Inc. (RFMH) is currently seeking a qualified candidate to serve as a Grade 22 Health Care Billing Specialist at the Office of Mental Health in Albany, New York.

Function and Scope:

RFMH is seeking a candidate that can serve as a member of a team to assist with billing State-operated behavioral health programs to Medicare, Medicaid, and health insurance plans. The candidate will work along with various OMH managers and staff, as well as health insurance plans.

The candidate will also support the continued transition to a modernized billing solution for NYS Office of Mental Health State-operated programs. The OMH recently replaced its legacy billing systems with a commercial off-the-shelf (COTS) billing system from Oracle Cerner, Soarian Financials. The COTS system replaced multiple systems used to bill for several behavioral health services including inpatient and outpatient services.

Job Duties and Responsibilities:

• Submitting mental health program service claims to various insurance plans.
• Reconciling payment of mental health program service claims to remittance statements.
• Assisting State staff with the maximization of cash flow from all payers.
• Working with clearinghouses and insurance plans, and the billing system vendor, to resolve billing edits, denials, and correct any discrepancies about claim submission and remittance statements.
• Educating and advising state staff on billing guidelines for various insurance plans.

The Candidate must demonstrate the ability to translate highly complex concepts in ways that can be understood by a variety of audiences. The incumbent will be required to interact with internal and external organizations (e.g., OMH financial, program and clinical staff, other NY State government agencies, and health insurance plans) so strong written and oral communication skills are required. The incumbent must have working knowledge of the Microsoft Office Suite and medical billing software, practice good organizational and interpersonal skills and be able to work within established deadlines.

Minimum Qualifications:

• Hold an associate degree from an accredited college AND two years of experience submitting health care claims to insurance plans in an automated environment.
• A high school diploma or GED may be substituted for candidates who can demonstrate five years of related experience.
• One year of working knowledge or experience with Microsoft Office (Word, Excel, Outlook, etc.)

Preferred Requirements:

• Understand reimbursement methodologies (e.g., Diagnostic Related Groups (DRG), Ambulatory Payment Classification (APC), and Ambulatory Patient Groups (APG)).
• Medical coding certification
• Experience with Oracle Cerner's Soarian Financials billing application
• Understand government insurance plans (i.e., Medicaid and Medicare), and commercial insurances and managed care, including both claims submission and remittance statement processes.
• Understand medical coding terminology (e.g., HCPCS, CPT and modifiers).

Working Location: 44 Holland Avenue, Albany, NY

To Apply: Submit an application through our website at https://rfmh.applicantpro.com/jobs/. Please note only applications submitted through our website will be considered.

The Mission of the Research Foundation for Mental Hygiene, Inc. (RFMH) is to promote the mental health of all New Yorkers, with a focus on providing hope and supporting recovery for adults with serious mental illness and children with serious emotional disturbances. Applicants with lived mental health experience are encouraged to apply. RFMH is deeply committed to supporting underserved individuals, organizations, and communities. To this end, RFMH is focused on implementing activities and initiatives to reduce disparities in access, quality, and treatment outcomes for underserved populations. A critical component of these efforts is ensuring that RFMH is a diverse and inclusive workplace where all employees' unique attributes and skills are valued and utilized to support the mission of the Agency. RFMH is an equal opportunity/affirmative action employer.

The Research Foundation is a private not-for-profit corporation and is not an agency or instrumentality of the State of New York. Employees of the Research Foundation are not state employees, do not participate in any state retirement system, and do not receive state fringe benefits. Excellent Benefits Package. Employer/Minority/Women/Disabled/Veteran Employer. VEVRAA 41 CFR 60-300.5(a) compliant.