Agency Profile: Spectrum Health & Human Services respectfully partners with adults, children, and families as they recover from behavioral, emotional, mental health and/or substance related disorders by offering individualized and meaningful opportunities of hope, empowerment and support to achieve self-defined improvements in their quality of life.

Full-time: 227 Thorn Avenue, Orchard Park, NY

SUMMARY OF POSITION FUNCTION:

Responsible for organizing, coordinating and monitoring billing related functions as assigned by and under the direction of the Director of Information Management; coordinating communications between the team members and internal and external vendors; maintaining accounting and financial records for client and payer related activity and operating the management information system.

MAJOR DUTIES AND RESPONSIBILITIES:

• Performs authorization verification functions’ obtains required information and addresses problems
• Works with site office staff to ensure that all insurance information, procedures and rules are current and adhered to
• Enters all financial related information into Anasazi within a 48 hour period and verifies accuracy
• Verification of diagnosis and assures demographic information is accurate
• Assures appropriate staff are assigned based on insurance rules, notifies Directors of potential case transfers
• Verifies and enters Insurance and private fee data including authorizations if required
• Verifies on multiple treatment episodes that Assessment Services do not exceed regulatory requirements. Notifies EMR department accordingly
• Tracks and verifies new clients financial data is received at Administration within 48 hours of assessment visit
• Works with site secretaries to correct information deficiencies and address problems
• Monitors all fee for service billing to ensure regulatory compliance and adherence to agency submission timeframes
• Processes Medicaid and 3rd Party Payer claims on a bi-weekly basis generating claim batches. Basic level and low volume of claims.
• Reviewing for any SED code changes, 0fill coding and 3rd Party adjustment codes
• Submits 837 files and verifies 277 acceptance file
• Processes follow-up on all pended and denied claims Basic level and low volume of claims.
• Processes all private fee monthly statements, no later than 1 workday after Fiscal Closing, work schedule must accommodate this process.
• Is responsible that all coding, pricing and authorizations updates are accurately reported to the Accounts Receivable Director for programming into the Anasazi software
• Adheres to Code of Ethics; reports all concerns and violations to management staff and/or Compliance Officer
• Operates office machines and instructs others in the operation of same

SKILLS/COMPETENCIES:

• Excellent interpersonal skills and communication skills both verbal and written
• Requires organizational skill and ability to make contacts and establish relationships to obtain information necessary for the program to functions within the larger system
• Meticulous documentation/recording skills and attention to detail; excellent time management and organizational skills
• Ability to handle multiple tasks
• Proficient in the use of computer software such as MSWord, Excel, Power Point, Desktop Publishing, Outlook, etc.
• Ability to operate office equipment

EDUCATION REQUIREMENTS:

• High School Diploma or equivalent

EXPERIENCE:

• One year work experience in work related field preferable

Must possess a valid Driver’s License with an acceptable driving record