Billing and Claims Specialist

Cardinal McCloskey Community Services•Town of Mount Pleasant, NY

2d•$60,000 - $65,000

About The Position

CMCS (Cardinal McCloskey Community Services) seeks a detail-oriented Billing and Claims Specialist to manage billing, claims processing, payment posting, denial resolution, accounts receivable follow-up, collections, and invoicing across a diverse range of agency programs. The role supports timely and accurate reimbursement for behavioral health, healthcare, children's services, and developmental disability programs while maintaining compliance with state, federal, insurance, and contract requirements. The specialist works closely with program, clinical, administrative, and finance teams to maximize revenue, support financial sustainability, and ensure that services are accurately documented and billed. The ideal candidate is organized, proactive, and committed to excellence.

Requirements

Experience with Electronic Health Record (EHR) and billing systems.
Thorough understanding of medical claims billing, accounts receivable management, and reimbursement processes.
Knowledge of Medicaid, Medicaid Managed Care, Medicare, commercial insurance, and government-funded billing requirements.

Nice To Haves

Bachelor's degree preferred.
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.
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 in accordance with funding source requirements and established 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 ensure timely reimbursement.
Process claim corrections, adjustments, voids, and resubmissions as necessary.
Monitor and analyze accounts receivable and aging reports, and follow up promptly 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.