Billing-Entitlements Specialist-11552501

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 the full billing process for assigned ACT teams, and ensures assigned ACT team clients have active Medicaid, track and manage the insurance status and enrollment/recertification (and any barriers to such), 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 weekly to provide billing and entitlements updates and lend support all ACT Billing and Entitlements team members. Includes supporting insurance authorization process and calls/meetings around insurance needs, benefits enrollment and access, and submitting other managed care and relevant information as needed.

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.)

• Attend meetings and interface with Managed Care Organizations (all ACT teams).
• Track and report monthly level of service encounters.
• Work with finance and other relevant departments to process all necessary steps to successfully complete monthly billing for assigned ACT teams.
• Work with assigned ACT teams to ensure all progress notes are complete, and communicate any issues/concerns regarding completion, as it relates to billing.
• Attend assigned ACT team meetings at least once weekly to review any issues/updates as it relates to client's coverage/benefits and attend all scheduled meetings (including but not limited to bi-weekly ACT denial meetings and Supervision).
• Send end of month billing reminder emails and update emails in billing processes (assigned teams)
• Maintain entitlements and case records of assigned ACT team clients, including formally tracking assigned ACT clients' Medicaid recertification dates, those clients on spenddown, and creates the necessary reports and systems to appropriately monitor, secure, and maintain Medicaid and/or alternative coverage for assigned ACT team clients. Track clients on assigned ACT teams whose insurance reactivates, so they may be back billed and notify finance and all appropriate parties to do so.
• Review and maintain appropriate inter and intra agency documents and information related to assigned ACT team clients' entitlements.
• Checks ePaces, MAPPS (and any other related portals) as scheduled by VP of ACT Programs and keep/share a formal log, to ensure all clients insurance status is active and up to date, and that clients are not dually enrolled in programs.
• Manage Medicaid spenddown process assigned ACT teams clients: provide technical assistance to consumers, ACT team members, and other appropriate members regarding the management of surplus Medicaid. Ensure monthly invoices are prepared and sent to appropriate entities.
• Serve as client advocate when needed, as it relates to billing/entitlement: include making field visits and scheduling office appointments as necessary to assist clients and with clients. Serves as a client advocate as it relates to benefit court hearings, Medicaid and food stamps fair hearings (and documenting in EHR). Collect and process all documentation and forms used to help ICL consumers during their hearings.
• Maintain and report client insurance status as needed: uses EMENDY, managed care portals, EHR and other tool/portals to report and monitor correct insurance of all assigned ACT teams clients (frequency to be determined by VP of ACT Programs and AVP of Compliance. Ensure information is appropriately documented and updated in EHR. Communicate any and all reports and updates to all relevant parties as necessary.
• Maintain knowledge and expertise: utilize all appropriate portal access and collaborate with VP of ACT Program and AVP of Compliance to ensure accurate understanding of all issues/updates around insurance, Medicaid, and other entitlements issues and changes.
• Serves as a dependable and accurate resource of entitlement information for ICL Management and direct-care clinical staff.
• 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.
• Excellent understanding of Social Security, Medicaid, Medicare, and other government entitlement programs.
• 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.