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Submits bills to New York State AIHP for eligible outpatient and emergency medical services and assists clients with billing/insurance questions, reimbursement timeframes and eligibility.
Duties & Responsibilities:
Submits bills for outpatient and emergency medical services.
Assists client with billing and insurance questions, reimbursement timeframes and eligibility.
Works with outside providers, billing offices and collection agencies on behalf of the clients regarding billing and insurance issues.
Completes various vouchers to ensure accurate and prompt payment.
Maintains an accurate year-to-date log of the number of bills submitted and total dollar amount; submits monthly reports to PRC Business Office Manager.
Follows-up on outstanding claims for payments.
Attends Utilization Review Committee meetings and any other meetings as designated by the Clinical Director, Health Operations Director or PRC Business Office Manager.
Serves as back-up for PRC Billing Specialist.
Adheres to all Oneida Indian Nation Health Center services security and confidentiality policies and procedures in regards to all daily job functions and receives annual up-date training regarding each area.
Serves as support as needed for Referral/ Patient Enrollment Specialist.
Obtains prior authorization when needed for AIHP eligible patients.
Coordination of Durable Medical Equipment for patients in need to include knowledge of insurance coverage requirements, verify that proper medical documentation is available, work with outside DME companies to obtain the equipment needed as soon as possible.
Education of clinical staff on DME insurance documentation guidelines so that accurate documentation is available that DME provider and insurance requirements are met upon first submission for quicker service to the patient.
Performs other duties as assigned.
Minimum Qualifications:
High School Diploma or Equivalency.
Must have two to three years of experience in a medical or insurance office.
Must be familiar with Medicaid reimbursement rates and reimbursement guidelines.
Must have a working knowledge of CPT and ICD-9 coding.
Computer experience to include Microsoft Word and Excel.
Strong communications skills.
