Job Title

Billing Specialist

Location Address

4025 Chestnut ST, Philadelphia, Pennsylvania 19104

Job Description

Pay Range:

$19 To $25 Per Hour based on experience.

Schedule :

Mon-Fri 8am to 4pm

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 unresolved 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-16839

Alternate Locations

4025 Chestnut ST, Philadelphia, Pennsylvania 19104

Full-Time/Part-Time

Full-time

Union/Non-Union

Non-Union

Area of Interest

Accounting/Finance, Administration, Healthcare Services