Clinic Billing Coordinator

POSITION SUMMARY

The Clinic Billing Coordinator assists in overseeing the accurate, timely, and compliant billing and reimbursement activities for Article 16 Clinic services. The position is responsible for supporting the complete revenue cycle process, including eligibility verification, claim preparation and submission, payment posting and reconciliation, denial management, accounts receivable follow-up, provider enrollment, and coordination with internal programs and external payers.

The Clinic Billing Coordinator works closely with the Billing Manager, Article 16 Clinic, and external agencies to ensure services are billed in accordance with Medicaid, Medicare, third-party payer, OPWDD, CMS, and other applicable regulatory and payer requirements.

DUTIES AND RESPONSIBILITIES

Coordinate the accurate and timely submission of Article 16 Clinic claims to Medicaid, Medicare, Medicare Advantage plans, and other third-party payers.
Generate, review, and process electronic eligibility transactions, including 270/271 eligibility files, to verify coverage and determine the appropriate payer and coordination of benefits.
Review billing information for completeness and accuracy prior to claim submission, including payer information, provider information, service dates, procedure codes, modifiers, authorizations, and other required billing elements.
Prepare, transmit, monitor, and reconcile electronic claims, including applicable 837 claim transactions.
Retrieve and review claim acknowledgement and status reports, including 277 transactions, and investigate and resolve claim rejections in a timely manner.
Review and reconcile electronic remittance advice and payment files, including 835 transactions, to ensure payments, adjustments, denials, and patient responsibility amounts are accurately reflected in the billing system.
Research, correct, and resubmit denied or rejected claims within applicable payer timely-filing requirements.
Perform ongoing follow-up of outstanding accounts receivable and assist in maintaining aging balances within established departmental targets.
Identify recurring billing issues, denial trends, payer problems, system discrepancies, and reimbursement concerns and escalate significant findings to the Billing Manager.
Coordinate with Article 16 Clinic staff to resolve billing discrepancies, missing information, authorization issues, eligibility concerns, and other matters affecting reimbursement.
Communicate with external entities, including OPWDD, Medicaid/eMedNY, Medicare, managed care organizations, clearinghouses, and other third-party payers, as necessary to resolve billing and eligibility issues.
Assist with provider enrollment, revalidation, credentialing, and maintenance of provider information with Medicaid, Medicare, managed care organizations, and other applicable payers.
Monitor payer requirements, billing guidelines, reimbursement policies, and regulatory changes that may impact Article 16 Clinic billing.
Maintain accurate billing documentation and supporting records in accordance with organizational policies, payer requirements, HIPAA, Medicaid, Medicare, OPWDD, OMIG, CMS, and other applicable regulatory requirements.
Assist with internal and external billing audits, compliance reviews, claim research, and requests for supporting documentation.
Maintain appropriate safeguards for confidential patient, financial, and protected health information.
Prepare billing reports, reconciliation reports, denial reports, accounts receivable reports, and other financial or operational reports as requested by management.
Assist the Billing Manager with workflow monitoring, problem resolution, special projects, staff support, and other revenue cycle initiatives.
Participate in departmental meetings, training, and process-improvement initiatives designed to improve billing accuracy, reimbursement, compliance, and operational efficiency.
Perform other duties and responsibilities as assigned.

POSITION REQUIREMENTS:

Associate degree in Business Administration, Healthcare Administration, Accounting, Finance, Health Information Management, or a related field preferred. Relevant healthcare billing experience may be considered in lieu of degree requirements.
Minimum of three years of healthcare billing, revenue cycle, claims processing, or reimbursement experience.
Experience with Medicaid and Medicare billing required; experience with New York State Medicaid and OPWDD Article 16 Clinic billing strongly preferred.
Working knowledge of electronic healthcare transactions, including eligibility, claims, claim acknowledgements, and electronic remittance processes.
Knowledge of CPT, HCPCS, ICD coding principles and healthcare reimbursement methodologies.
Professional coding or billing certification, such as CPC, CPB, or equivalent AAPC/AHIMA certification, preferred.
Experience researching claim denials, payer requirements, eligibility issues, coordination of benefits, and timely-filing requirements.
Proficiency with electronic health record systems, billing software, payer portals, clearinghouses, Microsoft Excel, and other Microsoft Office applications.
Strong analytical, reconciliation, problem-solving, and organizational skills.
Ability to manage multiple priorities, meet billing deadlines, and maintain accuracy in a high-volume environment.
Strong written and verbal communication skills with the ability to communicate effectively with clinical staff, management, government agencies, and insurance representatives.
Knowledge of HIPAA, Medicaid/Medicare compliance requirements, fraud and abuse prevention, and healthcare billing documentation standards.