Medicaid Billing & Compliance Manager

Position: Medicaid Billing & Compliance Manager

The Medicaid Billing & Compliance Manager is a key member of the finance team overseeing the day-to-day billing operations of the division's programs and contracts, furthering the finance and program administration goals of the organization. Applies sound business practices to enhance the effectiveness and efficiency of the sector's programs. Provides support and advises the Business Manager on revenue and operational matters in accordance with Volunteers of America - Greater New York, Inc. policy and procedures. This position will supervise billing staff.

Location: Rahway, NJ 07065

Minimum Qualifications:

• Bachelor's degree in Accounting, Finance, Business Administration or Healthcare Management with a minimum of three years of relevant billing and operational experience, including at least one year in a supervisory capacity, or satisfactory combination of education and experience is required.
• Relevant experience includes similar fiscal and operational roles in a social service agency with federal and/or New Jersey state government agency contracts, or internal audit or public accounting experience, who is able to translate her/his understanding of agency funding, controls and workflow into effective and efficient fiscal operations and process improvement.
• This employee will possess a thorough understanding of medical billing and collections, Medicare/Medicaid, and managed care organizations.
• Working knowledge of CMS regulations, CPT/HCPCS codes, claim submission, and insurance regulations, billing, benefits and appeal processes is required.
• Knowledge of business management and basic accounting principles is required. Knowledge of contract negotiations and credentialing is preferred.
• Must have strong communication skills, both written and verbal. Strong attention to detail with the ability to organize work and perform duties with a high level of accuracy is required. Also have a collaborative work style and excellent interpersonal skills.
• Advanced proficiency with Microsoft Office suite with strong Excel skills is required. Experience with EHR systems is required; AWARDS proficiency is helpful.

Billing Specialist Principal Responsibilities:

1. Oversee the operations of the medical billing function, encompassing coding, claims preparation and submission, payment posting and reimbursement management. Contribute to automating and streamlining billing processes to enhance operational efficiencies.
2. Perform prospective review of medical billing documentation. Ensure claims are complete and accurate and submitted in compliance with federal and NJ state regulations.

1. Manage Medicaid/Medicare eligibility and prior authorization processes. Ensure eligibility is verified and prior authorization obtained to support billable services.
2. Manage claims denial processes ensuring denials are escalated and appealed by the stated deadlines.
3. Review monthly revenue reporting and monitor receivables and cash flows. Perform analyses and reconciliations to ensure accurate billing and financial reporting. Provide monthly and ad hoc reporting as requested.
4. Assist in negotiating contracts with managed care organizations. Track contract expiration dates and manage contract renewal process. Maintain effective relationships with all payor organization representatives.
5. Maintain a high level of proficiency in navigating the EHR system and payor portals.
6. Supervise the billing staff and coordinate training on applicable operating policies, systems and techniques. Cross-train in billing functions to serve as back-up as needed to meet billing and reporting deadlines.
7. Keep current with CMS and NJ funder regulations and distribute change information appropriately.
8. Participate in external and internal audits and funder monitoring procedures. Actively support and comply with all components of the compliance program, maintain confidentiality and abide by HIPAA and PHI guidelines.

Employees receive an exceptional benefits package including:

• Medical
• Dental
• Vision
• Prescription coverage
• Life insurance,
• Retirement plan
• Educational Reimbursement Program (includes tuition and license/certification)
• Paid Time Off which is accrued monthly and rolls over from year to year. In addition;
  
  
  
  • Paid Birthday Holiday
  
  
  
  

And much more...

To learn more about VOA-Greater New York, copy and paste this link into a browser: https://www.voa-gny.org/about

VOA-Greater New York is an Equal Opportunity Employer/Vets/Disabled/Other Protected Categories. Apply today!

• Rahway, NJ 07065, USA