Benefit & Collection Specialist - Agency Admin

Family Residences and Essential Enterprises, Inc•Bethpage, NY

18h•Onsite

About The Position

The primary role of the Benefit & Collection Specialist, under the supervision of the Billing Manager, is to facilitate efficient operations in insurance eligibility, authorization, and collections follow-up for FREE and the FREE Family Network. This role involves monitoring and tracking insurance eligibility, coordinating recertification processes, reviewing billing for accuracy, managing collections, and handling appeals for denied claims. The specialist will ensure timely communication with operations staff and payors, maintain accurate documentation, and assist with special projects and office operations as needed. Adherence to FREE's policies, including confidentiality, safety, and ethical conduct, is essential.

Requirements

High school diploma or equivalent required
Experience with medical billing and collections is preferred.
Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and other payor requirements and systems is preferred.
Familiarity with CPT and ICD-10 coding and medical terminology is preferred.
Familiar with Electronic Health Record (EHR) systems.
Proficient with Microsoft Office Suite, especially Excel.
Demonstrated ability to work in a team environment with flexibility, keeping others informed and anticipating needs is essential.
Must be efficient, detail oriented, well organized, and have excellent written and verbal communication skills.

Nice To Haves

bachelor’s degree in business, healthcare administration, accounting, or related field preferred.

Responsibilities

Monitors and tracks the eligibility status of all individuals enrolled in the Behavioral Health programs and ensures timely communication to operations staff in the programs where individuals are within 90 days of benefit recertification.
Assists operations staff to contact the appropriate parties to facilitate the recertification process, as needed.
Follows up with operations and tracks the status of the recertification process to ensure all recertifications are completed within the behavioral health regulations.
Assists in the review of behavioral health billing for accuracy and completeness prior to submitting billing, including prompt follow-up on any missing or incomplete billing, as needed.
Communicates proper coding and billing to operations teams as needed.
Reviews aging reports to ensure timely collections are being received.
Communicates past due balances to responsible parties for timely resolution.
Documents unresolved issues and presents to Billing Manager for additional follow-up.
Follows up on unpaid claims within standard billing cycle timeframe.
Researches denied and/or partial paid claims; reviewing all documentation and correspondence related to the claim, to properly determine the best course of follow-up.
Documents all communications on denied or partial paid claims, including name, date and time of person spoken to, case number, and/or reference number as available.
Files appeals for all denied and/or partial paid claims; follows up on appeals to ensure they are processed timely, and payments are received.
Notifies Billing Manager immediately of any issues in the billing process that lead to non-payment by a payor, such as incorrect codes or patient data.
Works on special projects; assist in office operations as needed.
Ensures that all required documentation (paper and electronic) is completed/processed appropriately, in a timely manner, and meets quality and compliance thresholds.
Perform other duties as assigned
Always communicate in a respectful manner with all people including the people we support, supervisors, other valued team members, and members of the community.
To comply fully with FREE’s confidentiality policies by holding in strictest confidence all information pertaining to members, residents, the people we support and their families, clients, providers, contractors, and employees.
Meets all safety training requirements; adheres to all safety policies and reports any and all unsafe conditions; takes measures to prevent accidents and/or eliminate conditions that pose a safety or health risk.
Coordinates, supports, attends and participates in all required events/ meetings/ reviews/ committees, including ones outside of standard working hours.
Meets all job requirements and stays in compliance.
Adheres to FREE’s standard of ethical behavior as outlined in the Employee Handbook and Code of Conduct as well as applicable laws and regulations.