Billing Specialist


Financial Services

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Branch Information

Poughkeepsie, NY - (USA) US Route 9 NY Poughkeepsie , NY 12601

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Job Description

Billing Specialist in finance department.

The hourly rate is $17.58-$18.68 - $32,000-$34,000 - 35 Hours/Week

The Billing Specialist is responsible for all aspects of claim payment and follow-up including payment application, denial management, appeals, re-billing and waterfall billing. This position will require extensive communication with payers and between internal departments. Reports to the Associate Director of Revenue Cycle Management.

Responsibilities:*Review, post and fully reconcile all 3rd Party and client payments through 835 file upload and manual entry including all necessary accounting functions

*Re-bill claims as needed and bill all payers in waterfall process

*Manage all 3rd party denials, identify trends, reporting and communicating with appropriate staff

*Complete all levels of appeals adhering to the payer specific appeal requirements

*Position requires extensive communication with 3rd party payers, clients and staff

*Respond to all 3rd party requests for information including refunds, medical records, provider and client data

*Examines claims, charges and payments for compliance with agency, 3rd party and regulatory requirements

*Provide regular periodic reports and updates on denials, unpaid accounts, payments and any issues impacting revenue

*Perform general billing duties including but not limited to: reconciling billed services; remittance processing, insurance denial follow up, collections and communicate billing and insurance issues to appropriate staff

*Effectively communicate with the vulnerable populations served by our agency as needed

*Maintain current and accurate account information in the client and agency systems

*Maintain current knowledge of all job specific requirements and related regulations


Education: High School diploma or GED, CPC License preferred

Experience: Minimum three (3) years' experience required in a medical-related environment and/or aptitude to understand medical billing and medical claim denial resolution based on prior work history. Previous Medicaid billing/EMEDNY preferred. Experience working with a diverse population preferred. Typing, data entry, general clerical and strong mathematical skills required.


*Knowledge of Medical Terminology, CPT, HCPCS and lCD-10 coding.

*Knowledge of NetSmart/ RevConnect and OMH reporting is a plus

*Excellent documentation, verbal and written communication skills

*Knowledge of Microsoft Office; especially EXCEL

*Attention to detail

*General math skills

*Knowledge of procedures and revenue cycle flow in a healthcare organization.

*Willingness to travel for agency business

*Ability to learn and work within agency procedures and guidelines

*Ability to exercise sound judgment in tracking sources of errors and in using established guidelines to determine the necessary corrective action