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Medical Biller

SOUTH SHORE SPEECH LANGUAGE

  • Babylon, NY
  • 10 days ago
  • Full-time

Highlights

Handle billing through NYSED/NYCPSE mechanisms , often tied to Preschool Programs in Approved Settings (PPS or CPSE programs). South Shore Speech is looking for a competent, responsible and dedicated individual to join our busy/fast paced, award winning team.

Numbers & Facts

LocationBabylon, NY
Job TypeFull-time

Description

South Shore Speech is looking for a competent, responsible and dedicated individual to join our busy/fast paced, award winning team
 
 Benefits and Perks:
 . Family/friendly work environment
 . Supportive management and staff
 . Employee appreciation events regularly
 . Teaching/training will be provided
 
 Qualifications:


. Certified Professional Coder
. Proficiency with Excel
 . Motivated and possess the ability to multitask
 . Past medical office experience necessary
 . Strong organization skills
 . Able to interact well and professionally with the public both in person and over the phone
 


Responsibilities:


1. Pre‑Authorizations & Verifications


  • Contact payers (e.g. Medicaid, private insurances, NICU-funded programs) to verify patient eligibility and coverage before treatment begins.
  • Submit pre-authorization requests for services requiring prior approval (e.g. speech therapy visits under Early Intervention or CPSE).
  • Track authorizations, monitor denials, and coordinate with clinical staff to obtain additional documentation or clinical rationale when needed.
2. Insurance & Third‑Party Billing


  • Prepare and submit claims to insurance carriers, including Medicaid, commercial payers, and EMR-based Early Intervention systems.
  • Monitor claim status, follow up on unpaid or denied claims, and resubmit corrected or appealed claims as necessary.
  • Reconcile payments, post EOBs (Explanation of Benefits) and ERA (Electronic Remittance Advice) data.
  • Patient billing: handle co-pays, deductibles, and out-of-pocket balances; send statements or coordinate payment plans.
3. Early Intervention Program Billing (NY‑EI)


  • Maintain understanding of NY State Early Intervention billing codes, rates, and service models (e.g. 1:1 vs. group, telepractice).
  • Submit EI claims via the NYSED portal or billing platform used by Early Intervention providers.
  • Coordinate with Service Coordinators and Special Instruction to ensure approvals and proper authorization.
  • Address denials or adjustments typical to New York’s EI system, including eligibility updates and end-of-year reauthorizations.
4. CPSE (Pre‑School Special Education) Billing


  • Handle billing through NYSED/NYCPSE mechanisms, often tied to Preschool Programs in Approved Settings (PPS or CPSE programs).
  • Submit claims either directly or through school district billing systems (e.g. IU–ITP).
  • Keep tabs on student eligibility, service plans (IFSP to IEP transitions), and annual authorization renewals.
  • Coordinate with district CPSE liaisons and parents around covered services and parental consent.
5. Documentation, Compliance & Reporting


  • Maintain accurate documentation of claims, appeal letters, rejections, and patient eligibility.
  • Stay current with New York health regulations, Medicaid policies, and best practices for Early Intervention and CPSE billing.
  • Generate reports (e.g. productivity, claim success rates, aging schedules, AR reports) for practice management and financial tracking.
6. Coordination & Communication


  • Liaise with SLP clinicians, administrative staff, families, schools, and external coordinators (e.g. Service Coordinators, CPSE offices).
  • Provide timely feedback on coverage limits, benefit exhaustion, and parental financial responsibility.
  • Offer support to front-desk or intake team to collect necessary patient/payer information upfront (e.g. prior authorizations, CPSE numbers).

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