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Under the direction of the Clinic Billing (Accounting) Manager, supports management and staff in assigned clinic(s) with the execution of timely and accurate bill processing through commercial insurance, Medicare and/or Medicaid and assessing eligibility for medical/clinical services received at Article 16 and Article 28 clinics. Ensures collection and posting of payments in compliance with all applicable rules and requirements by reviewing and submitting billing information and posting and reconciling payments received through applicable electronic systems. Coordinates necessary eligibility authorizations, conducts follow-ups and tracks accounts receivable by running reports and reviewing financial statements. Identifies, assesses and recommends solutions to various billing, eligibility and system problems, supporting implementation of new processes and procedures in collaboration with billing team. May be assigned to perform primarily eligibility or collections-related activities on a day-to-day basis, but performs collections and/or eligibility tasks as directed to support departmental needs.

Key/Essential Functions & Responsibilities

Reviews and interprets patient eligibility and claims data from various sources (explanation of benefits, remittance statements, collections reports, etc.) to assess the correctness of claims submitted for processing, identifying and communicating discrepancies, issues and/or missing information to the appropriate parties and coordinating corrections needed to avoid claim delays and to maximize reimbursement for services.  

Reviews and verifies patient insurance and contacts patients and/or authorized designees directly by phone to confirm or assist with obtaining eligibility, preauthorization and/or authorization for scheduled services or to assist with resolution of payment for services, establishment of financial agreements, coordination of benefit discrepancies, determining patient responsibility or medical necessity, regarding denials and/or to initiate appeals following services, which may include contacting and following up with applicable payors. 

Makes regular updates to patients’ electronic account records to reflect financial and/or eligibility-related changes including applying copayments and deductibles in accordance with established protocols, documenting communications, payments/payment plans, receipts, insurance, demographic or other eligibility information. 

Reconciles patient accounts and payments by reviewing and updating payment details from bank and other financial statements and resolving credit balances and account issues by researching and correcting posted payments and other information, as necessary. 

Makes corrections to claims in electronic systems (and on paper when applicable) and/or coordinates resolutions of claim issues with appropriate clinic or finance staff, updating and sharing applicable records and files to reflect claims issues and resolutions and making related notifications.

Regularly monitors electronic systems to review new and pending transactions and prepares/submits completed medical claims electronically (and when applicable by paper) to governmental, private pay and commercial insurance carriers in accordance with prescribed processes and procedures. 

Conducts follow ups on all claims from billing through final resolution to track claim status and coordinate billing edits or reviews relating to denials, payment errors and low reimbursement, ensuring claim submissions and resubmissions are handled in a timely manner. 

Provides back-up for other billing staff, performing additional eligibility and collections-related tasks and assists with special projects including tracking and reconciliation of data such as transit card program, as assigned. 

Develops and maintains a good working knowledge of applicable laws and regulations as they pertain to claims and eligibility, including the submission of claims and remains current with all related policies, procedures, guidelines and standards, including insurance-specific billing regulations. 

Performs a variety of clerical, administrative and financial tasks to support billing as requested including, but not limited to filing, copying, scanning and/or data entry; creating memos, lists, spreadsheets or other documents; and/or making notifications or inquires by email or phone.

Collaborates with clinic billing team to identify and resolve billing, eligibility and collection-related issues, including processing delays or concerns, low payments, denials or appeals, escalating concerns to supervisor for review and handling.

May assist with or collect data to support coordination of responses to audit requests received from external sources within required time frames, including year-end and other regularly scheduled audits, as directed by supervisor. 

Complies with all Federal, State, Local and other relevant regulatory agency requirements, including the Health Insurance Portability and Accountability Act (HIPAA) and insurance-specific billing regulations and ensures cooperation with appropriate entities in any inspection, inquiry or investigation.

Performs all other duties, as assigned.

Minimum Qualification Requirements including education, experience, licensure/certification, etc. and essential physical capabilities (e.g. lifting, assisting lifting, standing, etc.)

High school diploma or its educational equivalent; and  

Two (2) years of experience performing general administrative support, clerical and/or customer service duties in an office or healthcare setting including data entry, tracking data, accounts receivable, bookkeeping, eligibility or similar duties; or

Satisfactory equivalent combination of education, experience and/or training. 

Basic computer skills, including working knowledge of Microsoft Office, specifically Excel and Outlook and ability to learn electronic systems (e.g. Workday, electronic health record or similar databases and portals).

Working knowledge of medical terminology, disorders, diagnoses, treatments and/or medications.

Basic understanding of medical billing and terminology, medical insurance and/or eligibility.

Excellent interpersonal and customer service skills, including the ability to effectively communicate with patients, circles of support, clinic staff, insurance agents and other stakeholders at varying levels in an appropriate, consistent and straightforward manner, both verbally and in writing.

Strong customer service skills and professional manner, including the ability to appropriately explain technical details and adjust accordingly to ensure understanding.

Demonstrated time-management skills, including the ability to switch between and plan, organize and prioritize tasks to meet applicable deadlines.

Basic problem-solving skills and good judgment, including the ability to interpret instructions and solve practical problems relating to eligibility and billing.

Well-organized with strong record-keeping skills.

Ability to report on-site to our Manhattan office at least three (3) days per week in accordance with the Agency’s Return to Office Policy.

Ability to meet essential physical demands of position including: using hands to finger, handle or feel objects, tools or controls; sitting, standing, bending, twisting and reaching with hands and arms.

Preferred Qualification Requirements (desired requirements beyond MQRs above)

Previous experience performing clerical or medical receptionist duties in a healthcare facility.

Working knowledge and awareness of State and Federal billing guidelines, services and regulations.  

Schedule: Monday to Friday 9am to 5pm

Pay rate: $21.15

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, or status as a Vietnam or disabled veteran. YAI is an Equal Opportunity Employer.