Compliance and Billing Specialist

New York, Full-Time

·        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.


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