New Alternatives for Children, Inc. (NAC) is a child welfare agency in Midtown Manhattan that serves children with medical complexity, significant disabilities or severe emotional or behavioral conditions and their families through a range of clinical programs, healthcare and social services.
NAC has two NYS licensed onsite clinics: An Article 31 Mental Health Treatment Clinic and Article 28 Diagnostic & Treatment Center; and a Mobile Medical Clinic. The Billing and Contracts Administrative Supervisor will have overall responsibility for clinic billing and contracting functions, including day-to-day operations and staff supervision.
"WE ARE AN EQUAL OPPORTUNITY EMPLOYER, COMMITTED TO DIVERSITY"
MAJOR DUTIES & RESPONSIBILITIES:
- Review new and existing Medicaid Managed Care, Medicare and Commercial insurance contracts and amendments including scope of services, reimbursement and issues that pertain to day-to-day operations.
- Identify opportunities for improvements in new and existing contracts and address through initial negotiations and annual renegotiations.
- Expand number of agency contracts with Commercial and other insurance payers.
- Maintain current credentials on each provider including all information needed for credentialing and contracting, and monitor credentialing processes and timelines of each plan.
- Supervise clinic billing workflow, including generation and submission of Encounter Forms, medical coding, billing and payment posting.
- Enforce billing policies and procedures.
- Develop and implement systems to streamline processes and reduce billing errors.
- Identify and train all relevant staff in medical coding practices that optimize reimbursement.
- Manage and oversee service pre-authorization processes required by each plan, including tracking client utilization of pre-authorized service units and timeframes.
- Ensure timely billing and compliance with payer rules and deadlines.
- Oversee fee schedule rates for insurance plans to ensure proper remittances.
- Investigate billing problems, formulate and implement solutions.
- Work with insurance providers and others to resolve billing issues.
- Oversee claim resubmission projects as necessary, including preparation of information requests on unpaid or underpaid claims for resubmission to payers.
- Monitor updates/changes to billing rules, regulations and requirements and inform providers and billing staff.
- Generate monthly, quarterly and annual billing and remittance reports.
- Oversee ongoing implementation of Electronic Health Record (EHR) as it pertains to clinic processes and billing.
- Handle electronic and mail correspondence from payers.
- Perform other duties as assigned.
QUALIFICATIONS & COMPETENCIES:
- At least 5 years of experience in billing and contracting operations in clinic/practice setting, including supervision of staff and operations.
- Thorough knowledge of Medicaid Managed Care, Medicare and Commercial reimbursement practices.
- Experience in contract review, negotiation and administration.
- Knowledge of reimbursement systems, regulations and polices pertaining to coding, billing and documentation.
In addition the candidate must demonstrate the following competencies:
- Strong supervisory skills and ability to maintain excellent working relationships with staff and providers.
- Must be able to implement and manage billing operations, improve efficiency and maximize reimbursement.
- Highly detail oriented, ability to multi-task and follow-up.
- Strong computer skills.
37 West 26th Street, 7th floor
New York, NY, US 10010
Employment type:Full Time