Reference #: 5001005237406
Billing Specialist
4025 Chestnut ST, Philadelphia, Pennsylvania 19104Pay Range: $19 to $25 per Hour based on experience
Schedule: 8am to 4pm Monday through Friday
POSITION SUMMARY: The Billing Representative manages all medical assistance (MA)-related billing, provider payment, and reconciliation for Early Learning Services (ELS) preschool early intervention (EI) programs and is the primary liaison for providers regarding billing inquiries. This role ensures a smooth and compliant billing process through timely analysis of agency provider/ contractor data entry, daily monitoring units of service in the database, spot checks, data integrity audits, and reconciliation of all billing-related issues with contracted external agencies to ensure complete and timely MA payments to Elwyn.
DUTIES AND RESPONSIBILITIES:
Monitor and reconcile provider entries and run remittance reports to ensure proper billing and payment for assigned provider accounts
Perform regular audits to confirm appropriate billed services to ensure accurate and timely payments
Ensure compliance with Elwyn ELS billing practices, policies, and procedures by leveraging strong knowledge of the contractual requirements for providers, including the annual Billable and Non-Billable guidelines
Run electronic verification system (EVS) checks for MA billing eligibility through use of the state system which lists whether a child is eligible for medical assistance
Confirm receipt and run audit reports of MA consent by requesting information from regional leadership and Local Education Agency (LEA) Representatives concerning each child's billable services
Coach, guide, and train contractors in use of the Managed Service Portal (MSP) to enter units of service provided to ensure appropriate payment
Generate Medical Practitioner Authorizations (MPAs) for MA eligible children and send to physician for signature authorization of services to ensure maximum MA reimbursement to Elwyn for services rendered
Provide data to and collaborate with Billing Manager on the management of billing platform quarterly reporting including, but not limited to, tracking and reporting changes, contractor costs Service Verification Notes (SVN) from service delivery database for Philadelphia and Chester
Run daily reports from billing system in order to compile provider remittance reports
Compile and distribute monthly remittance files by extracting necessary data from the system database to external providers including a thorough review of the remittance data to ensure accuracy of the service data and the rates applied to each service included in the file
Provide consultation and training to providers in all billing-related matters to ensure consistency throughout the program and provide on-the-spot technical assistance
Work as a primary liaison maintaining frequent communication between Elwyn Early Learning Services and providers regarding all billing-related reconciliation issues in order to complete timely monthly remittance reports
Analyze data inconsistencies caused by provider data entry error and/or caused by providers completing Service Verification Notes (SVN) with errors and remediate the cause of the errors
Perform monthly reconciliations with provider agencies to address missing or inaccurate billing data included in the remittance files to ensure that reconciled billing entries are included in the next remittance file
Ensure timely submission of claim corrections and resubmission of Service Verification Notes (SVNs), Active Recorded Services (ARS), Remittance Reconciliations when necessary
Remain current with billing regulations regarding, but not limited to, School-Based Access Program (SBAP) to ensure compliance with said regulations
Receive problem/question communications from provider agencies, determine action needed, and monitor the problem to complete resolution
Address critical problems, as appropriate, otherwise communicate u resolved problems to the Lead Billing and Credentialing Specialist and/or Provider Agency as soon as possible to ensure timely resolution
Communicate effectively with staff, providers and agencies, management, office personnel from local, state, federal government and/or its third-party contractors, as necessary, to reconcile any billing related issues including SBAP
Perform other duties as assigned
IMMEDIATE SUPERVISOR: Billing & Credentialing Supervisor
DIRECT REPORTS: None
CONTACTS: Staff, provider and/or contracting agency employees, 3rd party contractors
EDUCATION/EXPERIENCE/SKILLS REQUIREMENTS:
High School Diploma or General Education Diploma (GED)
Two (2) years of experience in third party billing and collection procedures
One (1) year of experience with Medical Assistance (MA) billing
Experience with School-Based Access Program preferred.
Experience with contract review preferred.
Non-profit human service experience preferred.
Working knowledge of computer-based billing platforms; Sprout and Pennsylvania's Enterprise to Link Information for Children Across Networks (PELICAN) preferred.
Demonstrated ability to work effectively as part of a team.
Ability to work in a fast-paced environment and manage and prioritize multiple, often competing, priorities to meet deadlines.
Demonstrated strong attention to detail.
Demonstrated strong time management and organizational skills.
Demonstrated excellent judgment with the ability to independently solve problems and make decisions with little need for direct supervision
Demonstrated ability to anticipate future needed changes or identify problem areas and take effective actions
Demonstrated intermediate knowledge with Microsoft Office applications, including Word, Outlook, Excel, and PowerPoint
Must have current, valid driver's license in state of residence, three (3) years driving experience in the United States, and acceptable driving record.
PHYSICAL DEMANDS/ENVIRONMENTAL PROFILE: See Physical Demands Checklist below which represents the general physical demands and environment conditions to which the employee holding this position must meet, in addition to the duties and responsibilities listed above, to successfully perform the essential functions of this job. Elwyn will engage otherwise qualified candidates for this position whose disabilities may require reasonable accommodations to enable an individual to perform the essential functions.
Elwyn is an Equal Opportunity Employer. Elwyn does not discriminate on the basis of race, color, religion, creed, ancestry, pregnancy status, medical condition, gender, gender identity or expression, genetic information, sexual orientation or identity, age, national origin, citizenship, handicap status, marital or family status, mental or physical disability, perceived disability, military or veteran status, political activities or affiliations, or any other characteristic protected under applicable federal, state or local law, ordinance, or regulation.
ELW-16840
4025 Chestnut ST, Philadelphia, Pennsylvania 19104
Full-time
Non-Union
Accounting/Finance, Administration, Healthcare ServicesElwyn is an Equal Opportunity Employer. EOE AA M/F/Vet/DisabilityWe are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law.