Billing and Claims Specialist

115 E Stevens Ave, Valhalla, NY 10595, US | Salary | 60000-65000 per year | Full Time

Join a Team Where Your Work Truly Makes a Difference!

Safe Children, Stable Families, Successful Lives.

At CMCS (Cardinal McCloskey Community Services), our mission is to protect, empower and promote independence for at-risk children and families and those with developmental disabilities through quality community based services.

We are seeking a detail-oriented and motivated Billing and Claims Specialist to manage billing, claims processing, payment posting, denial resolution, accounts receivable follow-up, collections, and invoicing for a diverse range of agency programs. In this role, you will help ensure timely and accurate reimbursement for behavioral health, healthcare, children's services, and developmental disability programs while maintaining compliance with state, federal, insurance, and contract requirements.

The ideal candidate is organized, proactive, and committed to excellence. Working closely with program, clinical, administrative, and finance teams, you will help maximize revenue, support financial sustainability, and ensure services are accurately documented and billed.

Responsibilities:

• Prepare, review, and submit claims for Article 31 clinic services, Article 29-I services, CFTSS programs, and OPWDD-funded services, including IRA, Day Habilitation, Supported Employment, and Community Habilitation.

• Prepare and submit basic contract and program invoices in accordance with funding source requirements and established deadlines.

• Verify patient eligibility, insurance coverage, authorizations, referrals, service documentation, and demographic information prior to claim submission.

• Ensure claims and invoices are submitted in compliance with Medicaid, Medicaid Managed Care, Medicare, commercial insurance, OPWDD, OMH, OCFS, DOH, and contractual requirements.

• Review billing edits, claim rejections, and payer denials and take corrective action to ensure timely reimbursement.

• Process claim corrections, adjustments, voids, and resubmissions as necessary.

• Monitor and analyze accounts receivable and aging reports and conduct timely follow-up on unpaid, denied, or underpaid claims and invoices.

• Communicate with payers, funding sources, and program staff regarding claim status, authorization issues, reimbursement discrepancies, and outstanding receivables.

• Maintain detailed documentation of billing, collection, and follow-up activities.

• Accurately post payments, adjustments, refunds, and remittances and reconcile billing records as required.

• Maintain EHR and billing system information, including payers, plans, rates, procedure codes, and billing parameters.

• Identify billing, reimbursement, and revenue trends and communicate findings to management

Requirements:

• Bachelor's Degree preferred.

• Experience with Electronic Health Record (EHR) and billing systems.

• Thorough understanding of medical claims billing, accounts receivable management, and reimbursement processes.

• Experience billing OMH-licensed Article 31 clinics, Article 29-I services, CFTSS programs, and/or OPWDD-funded services, including IRA, Day Habilitation, Supported Employment, and Community Habilitation.

• Experience preparing and submitting NYC/NYS contract or grant-funded invoices preferred.

• Knowledge of Medicaid, Medicaid Managed Care, Medicare, commercial insurance, and government-funded billing requirements.

CMCS offers:

• Medical, Dental & Vision Insurance

• 403(b) Retirement Plan

• Generous Paid Time Off

• Flexible Work Schedules

Make a Difference Every Day

If you're ready to make a meaningful impact and be part of a compassionate, dedicated team, apply today and start your journey with CMCS!

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