Specialist, Third Party Billing

BCPS • Towson, MD

20h • $87,025 - $139,976

About The Position

Provides leadership, expertise, training, and assistance to service providers and others with respect to Medicaid reimbursements and other Office of Third Party Billing matters. Analyzes and develops program policies and procedures. Monitors and audits program compliance. Serves as project manager for automated system projects. Serves as a liaison to the Department of Information Technology and system vendors. Serves as a liaison between the Office of Third Party Billing and schools and offices. Supervises administrative support staff.

Requirements

• Graduation from an accredited college or university with a bachelor’s degree.
• Three years' professional experience as an administrator or systems analyst.
• Knowledge of Medicaid laws, rules, and regulations.
• Knowledge of the principles and practices of third party billing.
• Knowledge of the principles and practices of staff development.
• Knowledge of automated business systems, advanced reporting tools and coding.
• Demonstrated proficiency in principles and practices of computer/system administration.
• Advanced knowledge of programming languages, database management and data archiving methodologies.
• Knowledge of personal computers and office software applications.
• Skill in the development of training materials and presentations.
• Skill in providing in-service training.
• Skill in providing advice, guidance, and assistance to employees.
• Skill in analyzing procedures and practices and developing improvements.
• Skill in preparing reports and presenting data.
• Skill in trouble shooting system malfunctions.
• Ability to develop an expertise in the operation of automated applications and websites and verifies data integration between the medical billing systems and feeder systems, including various data systems.
• Citizenship, residency or work VISA in United States required

Nice To Haves

• Experience with Medicaid billing administration, staff development and training, or special education preferred.

Responsibilities

• Coordinates third party billing for case management and health-related services provided by special education teachers and related services providers.
• Provides advice, guidance, and consultation to service providers regarding third party billing and related matters.
• Receives and responds to questions and inquiries from service providers.
• Develops, revises, and produces training materials such as written guides, booklets, and manuals.
• Schedules and conducts in-service training workshops and sessions.
• Prepares and provide online and face to face presentations to school-based service providers and others.
• Reviews results from Third Party Billing school monitoring, Internal Audit monitoring, Interagency Medicaid Monitoring Team monitoring, and Federal and State audits.
• Analyzes monitoring results to determine when technical assistance is needed for school-based service providers.
• Reviews and monitors case management and health related services data and other materials submitted by service providers.
• Ensures that forms and materials are in compliance with applicable laws, procedures, and standards.
• Assists in planning and executing the goals and objectives of the Office of Third Party Billing.
• Ensures program compliance with the Health Insurance Privacy and Portability Act (HIPPA) of 1996.
• Collaborates with staff to determine the compliance levels of schools with regard to the submission of case management services.
• Conducts internal audits.
• Determines the number of case management and related service records received from service providers.
• Prepares reports which measure reimbursement and other program indicators.
• Keeps current with Medicaid laws and regulations.
• Analyzes and monitors Office of Third Party Billing processes strategies, systems and operations.
• Assists and coordinates various automation and operational improvement initiatives.
• Serves as the project manager for specified automated system projects.
• Tracks and reports project status.
• Serves as a liaison to the Departments of Special Education, Information Technology and billing vendor.
• Manages data integration from billing system, and various student and provider data systems.
• Collaborates and troubleshoots technical issues to improve efficiency of billing systems and office operations.
• Utilizes automated systems to research, gather, and report data.
• Collaborates with staff to identify information processing, reporting, and program requirements.
• Makes appropriate recommendations to the medical assistance billing vendor to effectively maintain and/or modify automated system.
• Administers and manages the Third Party Billing SharePoint and Schoology websites.
• Plans and provides technical guidance in the implementation, maintenance, and enhancements of Third Party Billing, Infants and Toddlers, School Based Health Center, IKC/OCLA, automated billing systems, associated software and server.
• Trains users on system enhancements and changes.
• Leads and oversees the testing of system integration and system updates to ensure the accuracy of data that drives the billing of Medicaid services provided to special education students.
• Collaborates with Supervisor to respond to auditor requests.
• Access automated information systems and document management solutions to best meet users’ requirements.
• Maintains reports.
• Develops and maintains reporting hierarchies in databases.
• Confers with users.
• Provides advice and guidance to departmental management regarding automation and operational issues.
• Represents the office in meetings and on committees.
• Performs other duties as assigned.

Benefits

• BCPS offers a comprehensive benefits program for eligible employees including options for medical plans, dental plans, vision, life insurance, flexible spending accounts, disability coverage, and 403(b)/457 plans.
• Other benefits include paid vacation, paid holiday’s, sick, personal business, and bereavement days, and flexible leave options such as FMLA, sick bank, and board approved leaves.
• All new hires will attend a benefits meeting upon hire.

What This Job Offers

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