Billing and Claims Specialist

Cardinal McCloskey Community Services•Valhalla, NY

About The Position

CMCS (Cardinal McCloskey Community Services) is seeking a detail-oriented Billing and Claims Specialist to manage billing, claims processing, payment posting, denial resolution, accounts receivable follow-up, collections, and invoicing for a range of agency programs. The role supports timely and accurate reimbursement for behavioral health, healthcare, children’s services, and developmental disability programs while ensuring compliance with applicable state, federal, insurance, and contract requirements. The specialist works with program, clinical, administrative, and finance teams to maximize revenue, support financial sustainability, and ensure services are accurately documented and billed. The position includes preparing claims and invoices, resolving billing issues, monitoring receivables, maintaining billing records and systems, and communicating billing trends to management.

Requirements

Experience with Electronic Health Record (EHR) and billing systems.
Thorough understanding of medical claims billing, accounts receivable management, and reimbursement processes.
Experience billing OMH-licensed Article 31 clinics, Article 29-I services, CFTSS programs, and/or OPWDD-funded services, including IRA, Day Habilitation, Supported Employment, and Community Habilitation.
Knowledge of Medicaid, Medicaid Managed Care, Medicare, commercial insurance, and government-funded billing requirements.

Nice To Haves

Bachelor’s degree preferred.
Experience preparing and submitting NYC/NYS contract- or grant-funded invoices preferred.

Responsibilities

Prepare, review, and submit claims for Article 31 clinic services, Article 29-I services, CFTSS programs, and OPWDD-funded services, including IRA, Day Habilitation, Supported Employment, and Community Habilitation.
Prepare and submit basic contract and program invoices according to funding-source requirements and deadlines.
Verify patient eligibility, insurance coverage, authorizations, referrals, service documentation, and demographic information before claim submission.
Ensure claims and invoices comply with Medicaid, Medicaid Managed Care, Medicare, commercial insurance, OPWDD, OMH, OCFS, DOH, and contractual requirements.
Review billing edits, claim rejections, and payer denials and take corrective action to support timely reimbursement.
Process claim corrections, adjustments, voids, and resubmissions as needed.
Monitor and analyze accounts receivable and aging reports; follow up on unpaid, denied, or underpaid claims and invoices.
Communicate with payers, funding sources, and program staff about claim status, authorization issues, reimbursement discrepancies, and outstanding receivables.
Maintain detailed documentation of billing, collection, and follow-up activities.
Post payments, adjustments, refunds, and remittances accurately and reconcile billing records as required.
Maintain EHR and billing system information, including payers, plans, rates, procedure codes, and billing parameters.
Identify billing, reimbursement, and revenue trends and communicate findings to management.