Health Insurance Biller, Bureau of Revenue

City of New York • Long Island City, NY

1d • Hybrid

About The Position

The Bureau of Revenue focuses on the optimization of insurance billing and reimbursements for services provided to insured New Yorkers seeking services in Article 28 Health Specialty Clinics, Article 36, and other Care Management service areas provided by DOHMH to meet NYS Article 6 requirements. DOHMH remains committed to providing services for NYC uninsured and underinsured residents. This position, reporting to the Assistant Director of Patient Billing, involves performing health insurance billing activities and support functions, including claim review, claim submission, follow-up, and collection activities, working alongside a team of talented health insurance billing specialists.

Requirements

• A master's degree from an accredited college with a specialization in business or public administration, financial management, or public health, and two years of full-time satisfactory experience in employee benefits or health insurance as a manager, research analyst, or underwriter, or in public health education. One year of such experience must have been in group benefits or group health insurance.
• A baccalaureate degree from an accredited college and three years of full-time satisfactory experience as described above.
• Education and/or experience equivalent to the above.
• Certification as a Certified Employee Benefits Specialist from the International Foundation of Employee Benefit Programs can be substituted for one year of experience.
• All candidates must have at least a baccalaureate degree and one year of experience in group benefits or group health insurance.

Nice To Haves

• Knowledge of medical terminology, eligibility and third-party reimbursement.
• Strong writing, speaking and active listening skills.
• Working knowledge of obtaining prior approvals via managed care payer portals.
• Excellent problem-solving and critical thinking skills.
• Knowledge of Health Insurance industry best practices.
• Basic knowledge of Article 28/36 New York State billing requirements.
• Working knowledge of Microsoft applications including Teams, Excel spreadsheets, PowerPoint and basic knowledge of accounting principles.
• Ability to work independently, collaborate with others, multitask, and be a team player.

Responsibilities

• Oversee billing and collection activities within the unit in close collaboration with the Assistant Director.
• Run and review daily billing reports for the unit, identify issues, and provide feedback to the Assistant Director.
• Track and communicate updated patient demographics and insurance information with clinic teams to ensure transparency.
• Track and manage medical records requests from MCOs to obtain prior authorization approvals and claim reimbursement.
• Review all claims (CPT/ICD-10/HCPCS, payment modifiers) in billing software to ensure accuracy following CMS and other third-party insurance guidelines.
• Monitor EDI denials in a timely manner.
• Review clearinghouse acceptance and rejection reports.
• Edit and make corrections to rejected claims and re-batch to third-party payers.
• Monitor aging accounts receivable reports (A/R) and provide feedback to the Assistant Director of Patient Billing.
• Report industry billing trends and changes to the Assistant Director of Patient Billing.

Benefits

• Federal/state loan forgiveness and repayment assistance programs.
• Premium-free health insurance plan.
• Additional health, fitness, and financial benefits may be available based on the position’s associated union/benefit fund.
• Public sector defined benefit pension plan.
• Tax-deferred savings program.
• Robust Worksite Wellness Program.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager