Billing-Entitlements Auditor-11552502

JOB SUMMARY:

Taking direction from the VP of ACT Programs and support of the AVP of Compliance, the ACT Billing and Entitlements Specialist will oversee treatment plan, billing and entitlements compliance for all ACT teams. Conduct audits of case records for documentation of service delivery to ensure accurate billing and work with team members regarding tracking of completion of the assigned ACT team treatment plans (to ensure billing is accepted), participate in ACT team meetings as assigned to provide updates and lend support all ACT Billing and Entitlements team members. Includes supporting all ACT teams with input to EHR policies & procedures in regard to ACT and billing; serves as lead liaison between ACT, IT, & Finances during the transition to EHR. This position will work closely with all ACT teams, ACT leadership, billing and entitlements staff, IT, and Quality Assurance as needed to troubleshoot and address billing, documentation, service delivery, finance, or IT Issues.

ESSENTIAL JOB FUNCTIONS: List all essential job duties. (To perform this job successfully, an individual must be able to perform each essential duty listed satisfactorily with or without a reasonable accommodation. Reasonable accommodations may be made to enable qualified individuals with a disability to perform the essential duties unless this causes undue hardship to the agency.)

• Serve as lead on new EHR policies and procedures for billing department, assist with training staff, as it relates to billing.
• Becomes familiar with and providers input to the EHR policies & procedures in regard to ACT and billing; serves as lead liaison between ACT, IT, & Finances during the transition to new EHR.
• Conduct audits of case records for documentation to support Medicaid billing invoices including but not limited to ensuring treatment plan dates, content, collateral identification, and signatures meet billing requirements.
• Conduct audits of case records for documentation of service delivery to ensure accurate billing include but not limited to ensuring frequency of service, modality (telehealth v. face to face), interventions, and person served (collateral v client) meet regulatory requirements.
• Maintain treatment plan tracking to monitor required billing elements & due dates and communicate documentation/service issues and/or upcoming due dates to the ACT teams on a consistent basis prior to service delivery and/or billing.
• Tracking of multiple and long-term inpatient hospitalizations to ensure conformance of billing as it relates to inpatient billing.
• Maintain, track, and encourage completed client consent forms allowing ICL to advocate on their behalf for benefits.
• Monitor all ACT team staff required CPI training completion rosters, initiate enrollment of all new staff, troubleshoot when needed.
• Collaborate and coordinate with ACT teams, ACT leadership, billing and entitlements staff, IT, and Quality Assurance as needed to troubleshoot and address billing, documentation, service delivery, finance, or IT issues.
• Provide consultative, technical, and training support to program staff regarding billing documentation standards and strategies for enabling conformance to such standards. This includes presentations to new employees and periodic presentations to existing employees on billing-related standards and other designated topics.
• Maintain current knowledge of applicable federal and state laws, regulations and accreditation standards that pertain to ACT billing including but not limited to Medicaid, OMH, DOHMH, and third-party insurances.
• Perform other related duties as required and assigned by Supervisor or VP of ACT Programs.

ESSENTIAL KNOWLEDGE, SKILLS AND ABILITIES:

• Committed to active promotion of ICL values and goals.
• Must demonstrate professional and respectful verbal and written communication skills along with developed computer literacy (MS Word, Excel, Outlook, Teams) and excellent organizational skills.
• Ability to prepare accurate and timely documentation, reports and other written material as assigned.
• Ability to secure the cooperation of and work effectively with others.
• Ability to work in a team-based environment, and to conform to all applicable safety and accountability measures.
• Demonstrates knowledge of, and supports the agency mission, vision, and value statements, standards, and the code of ethical behavior.
• Ability to respond to inquiries or complaints, including those of a sensitive and confidential nature in a timely manner; answer email and phone queries quickly.
• Ability to interact with a variety of managers, employees, insurers, regulatory agencies and clients/consumers and their families.

QUALIFICATIONS AND EXPERIENCE:

• Bachelor's degree in social/human services or related area of service plus 2 years of relevant experience. Understanding of the health care system.