Billing Specialist

Valence Care - HCS - Girling NY - Extended Home Care - A&J Staffing - A Better Life - Direct Care•New Hyde Park, NY

9d•Onsite

About The Position

Liaise between Extended Home Care clinical staff and all Managed Care contracts to facilitate the timely receipt and processing of authorizations for patient services. Provide supervision and oversight to the HMO Department and HMO Specialists in effectively managing authorization requests and denials.

Requirements

Associate degree or five years relevant work experience required
Minimum of two years’ experience working with HMOs and/or Commercial Health Insurances and knowledge of Managed Care regulations
Ability to work cooperatively with others, support team decisions, and solve problems independently
Ability to manage a team and oversee daily assignments and performance
Strong verbal and written communication skills
Strong organizational and prioritization skills for processing authorizations and clinical reports
Proficiency in Outlook, Excel, Word, and related applications
Familiarity with McKesson or other EMR platforms

Nice To Haves

Bachelor’s Degree preferred
Previous experience working in a supervisory capacity preferred

Responsibilities

Collaborate with EHC Case Managers/COC’s and Clinical Managers to formulate service requests
Obtain and maintain authorizations for the HMO Department
Create formal authorization requests using clinical documentation (visit notes, orders, SOC notes, etc.)
Generate and submit Managed Care Request Forms via Horizon/McKesson in a timely manner
Liaise with Managed Care and HMO contracts regarding approvals and denials
Handle inbound/outbound calls with payers regarding verbal authorizations
Enter authorization determinations (verbal, electronic, fax) into Horizon/McKesson
Verify authorization details including numbers, timeframes, and approved/denied services
Audit visits completed vs. approved visits and request additional services when needed
Organize pending authorizations by payer, urgency, and timelines
Follow up on outstanding authorization requests
Document authorization status and delays in McKesson
Notify Case Managers of authorization updates via system, email, and calendar
Assist Billing with authorization discrepancies and monthly reconciliations
Maintain updated payer contact lists and build strong working relationships
Supervise HMO Specialists and provide coverage as needed
Resolve day-to-day operational issues within the HMO Department
Coordinate staffing, assign workloads, and monitor productivity/quality
Establish workflows, schedules, and improve efficiency
Prepare and submit weekly/monthly reports to DPS
Perform additional duties as assigned
Ensure compliance with corporate policies and report any suspected violations