Compliance and Billing SpecialistNew York, Full-Time
About the Collaborative for Children and Families (CCF)
The Collaborative for Children and Families (CCF) is a New York nonprofit which includes over 40 member agencies (CMA- Care Management Agencies) that serve children and families throughout the five boroughs of New York City, Westchester, Nassau and Suffolk Counties. We offer comprehensive health and human services to children and families in a more coordinated manner than could be achieved individually, and seek partnerships with other components of the health and human services systems to integrate care for those in greatest need.
We respond in part to external forces including New York State initiatives such as Children’s Health Homes and the evolving managed care programs in medical and behavioral care for Medicaid-eligible children. The Collaborative also seeks to strengthen internal capacity and improve service delivery and outcomes for the children and families in our communities by working together.
Collectively, CCF serves nearly all the youth in foster care in the greater New York City area and nearly 60 percent of the children and families receiving preventive care. On any given day, Collaborative members serve more than 30,000 children, providing foster care, preventive care, early childhood education, schools and educational programs, behavioral health, school-based mental health, case management, summer camps, after-school programs, and residential treatment.
· Running daily reports, analyzing CMA compliance with expected standards, daily QA of data files and error resolution with CMA’s.
· Lead liaison between CCF and CMA’s related to billing errors, managing error reports, and error resolution
· Serve as go-between with CCF’s outside accounting/CFO and medical billing vendors providing relevant information about billing, invoices, deposits and business decisions to ensure deadlines and schedules are met.
· Prepare regular status reports on the performance of the programs and on any issues that may require their attention.
· Work under the direction of the Compliance and Quality Improvement Officer to ensure CMA’s are effectively monitored and in compliance with city, state and federal regulations
· As directed by supervisor, act as liaison with representatives from funding agencies on issues that affect the program.
· Undertake special projects and prepare special reports as assigned by CCF Executive Director, CCF Compliance Officer, CCF Fiscal Committee, CCF board treasurer, or external Accountant/CFO.
· Provide back-up assistance to other contract staff.
· Perform routine batch imports and exports to various systems
Working with our Accounting/CFO vendor
· Submit invoices, billings and reports for reimbursement and billing purposes.
· Reconcile medical billing submissions prepared for payment.
· Assist billing vendors in preparation of budget and fiscal related reports.
· Prepare audit schedules and analyses required by auditors. Investigate audit findings and recommend corrective actions in deficiencies noted.
Working with Care Management Agencies
· Running daily reports related to billing, member census data, SQL query data and working with CMA’s to clean up any errors
· Daily processing new referrals and assigning cases to CMA’s
· Working with Compliance Officer on any compliance related activities to monitor CMA data, adherence to policy and ensuring compliance with city, state, and federal requirements
Working with our Medical Billing Vendor
· Act as liaison between Millin Associates, CCF Member agencies to assist with claim inquiries, billing errors and other identified billing issues.
· Create monthly case reports on Per Member Per Month (PMPM) charges and case Billing Accruals generated by Millin and/or through the state’s MAPP system.
· Work with Program Coordinator to identify and correct possible data validation errors to ensure they do not become billing issues in the future. Communicate these errors with the responsible CMA.
· Assess and identify fiscal requirements in contract and grants, and manage requirements related to the contracts, including establishing and maintaining records to keep track of contract receivables, maintaining a billing and collections schedule for all contracts.
· Minimum Bachelor’s degree.
· Experience managing large data set with Excel, creating pivot tables, using sorting/filtering criteria and creating reports for presentation to managers and board of directors.
· Comfortable with Billing Data Concepts (Accounts Receivable, Claims, Remittance, Denials, etc.)
· Understanding of Health Home service concepts being provided in relationship to billing requirements
· Knowledge of the NYS Medicaid eligibility requirements and benefits (i.e. coordinating with ACS or Local Department of Social Services
· Knowledge of Office of Medicaid Inspector General (OMIG) rules and regulations
· Knowledge with government contract billing and reimbursement
· Able to read EOBs and Medicaid remittances
· Ability to manage overview of billing workflows
· Comfortable in a wide range of technology and systems (MillinPro, GSI, MAPP, ePaces, etc.)
· Medical Billing strongly preferred
· Excellent time management and documentation skills
· General math skills with particular attention to detail
· Microsoft proficiency: Word, Excel, PowerPoint
· Able to work well with colleagues in order to identify, resolve and share information in regards to the billing flow
· Able to handle expected volume of work/quickly resolve problems and escalate appropriate problems to management.
· Adapts well to change.
· Excellent communicator with good interpersonal skills
· Ability and willingness to attend workshops/trainings/webinars upon request.
· Accepts responsibility for accuracy of data
· Ability to work independently with little supervision
· Applies common sense understanding to carry out detailed but uninvolved written or oral instructions