Medical Billing Specialist

Tompkins County Whole Health is seeking an experienced Medical Billing Specialist to oversee the Department’s day-to-day medical billing functions. This is a 40-hour-per-week position with a hire rate of $31.48 per hour and a working rate of $34.13 per hour after nine months.

This position performs specialized, full-cycle billing across multiple mental health and public health programs. Responsibilities include reviewing claims for accuracy and readiness, submitting electronic and paper claims, resolving complex denials and underpayments, processing appeals, reconciling payments and adjustments, monitoring accounts receivable, and coordinating provider and service-location enrollment.

The Medical Billing Specialist also serves as a key resource to clinical, program, fiscal, and administrative staff. The position interprets changing Medicaid, Medicare, managed care, and commercial insurance requirements; develops procedures for new or expanding services; trains staff; and works with payers, eMedNY, clearinghouses, electronic health record vendors, and other partners to resolve billing issues. This work plays an important role in supporting Department revenue, regulatory compliance, and accurate, efficient service delivery.

The ideal candidate has strong medical billing and problem-solving experience, excellent attention to detail, and the ability to manage competing deadlines. They should be comfortable interpreting complex payer requirements, identifying billing trends, explaining requirements to staff, and handling protected health and financial information with sound judgment and discretion.

MINIMUM QUALIFICATIONS: 

(A.) Completion of a bachelor's degree in health information technology, medical billing and coding, accounting, business administration, health administration, or a closely related field, and one year of full-time paid experience performing medical billing that included electronic claims and Medicaid, Medicare, or commercial-insurance reimbursement; or 

(B.) Completion of an associate's degree in health information technology, medical billing and coding, accounting, business administration, health administration, or a closely related field, and three year of full-time paid experience performing medical billing that included electronic claims and Medicaid, Medicare, or commercial-insurance reimbursement; or 

(C.) Graduation from high school or possession of a high school equivalent diploma, and five years of full-time paid experience performing medical billing that included electronic claims and Medicaid, Medicare, or commercial-insurance reimbursement; or 

(D.) Any combination of education and experience as defined by the limits of any of the above
SPECIAL REQUIREMENTS: 
The employee must maintain any payer, portal, identity-verification, exclusion-screening, or confidentiality requirements necessary to perform assigned billing functions. Appointment may be contingent upon completion of background or exclusion checks required for access to Medicaid, Medicare, payer, or health-information systems.

DISTINGUISHING FEATURES OF THE CLASS: 

The work involves responsibility for specialized, full-cycle medical billing for Tompkins County Whole Health. The incumbent interprets and applies complex Federal, State, and payer requirements; determines claim readiness; and independently resolves non-routine claim edits, denials, underpayments, recoupments, and appeals involving Medicaid, Medicare, managed care, and commercial insurance. Work is performed under general supervision with broad discretion and independent judgment. The incumbent serves as the Department’s billing liaison to clinical, program, fiscal, and administrative staff, translating payer and regulatory requirements into coordinated operating practices. The incumbent designs and implements billing procedures for new or expanding services and coordinates cross-program performance-improvement initiatives affecting documentation, compliance, workflow efficiency, and reimbursement. The incumbent serves as a professional liaison with payers, government billing contacts, clearinghouses, and system vendors. The incumbent may supervise work groups, interns, or project assistants, and the incumbent is responsible for overseeing the day-to-day billing functions of the department. The work directly affects County revenue, regulatory compliance, and audit exposure

TYPICAL WORK ACTIVITIES: 

Researches, interprets, and applies differing Federal, State, program, and payer requirements governing billing across multiple Mental Health and Public Health programs. • • Reviews client, coverage, provider, service, authorization, and charge information to determine claim readiness. Verifies eligibility, benefits, managed-care enrollment, coordination of benefits, authorizations, and other payer requirements. • Reviews billing documentation and applies approved codes, modifiers, rates, units, provider identifiers, and service locations. • • Coordinates provider and service-location enrollment, revalidation, rosters, and payer-file maintenance. Interprets complex billing requirements, resolves billing-related errors, and secures corrective action from clinical, program, intake, fiscal, and administrative staff. • Coordinates implementation of consistent billing procedures across multiple clinical programs, adapting guidance to differing services, workflows, and payer requirements. • • Provides billing guidance and training to clinical, program, intake, fiscal, and administrative staff. Creates, submits, and monitors electronic and paper claims through the electronic health record, eMedNY, clearinghouses, and payer portals. • Resolves claim edits, rejections, and denials; corrects and resubmits claims; and prepares appeals with supporting documentation. • • Determines payer order and processes crossover and coordination-of-benefits claims. Posts and reconciles payments, adjustments, denials, refunds, voids, and recoupments; investigates account discrepancies. • • Maintains accounts-receivable and aging work queues; prioritizes filing and appeal deadlines; follows up with payers. • Analyzes denial, payment, and aging trends; prepares reports and recommends corrective actions. • Interprets changes in payer and regulatory billing guidance and updates billing procedures and reference materials. Works with payer, eMedNY, clearinghouse, electronic health record, and vendor representatives to resolve technical billing problems. • Supports audits and recoupment responses by retrieving records, reconciling billing data, and documenting corrective actions. • • Communicates with clients or responsible parties to verify coverage and resolve billing questions. • Tests billing workflows and claim edits following system or payer changes and reports defects. • Maintains complete, confidential, and auditable billing records in accordance with retention and HIPAA requirements. • Performs related work as required. 

KNOWLEDGE, SKILLS, ABILITIES AND PERSONAL CHARACTERISTICS:

 • Thorough knowledge of medical billing, reimbursement, denial resolution, appeals, and accounts-receivable practices. Thorough knowledge of Medicaid, Medicare, managed care, commercial insurance, and Mental Health and Public Health billing requirements. • • Thorough knowledge of CPT, HCPCS, ICD-10-CM, rate codes, modifiers, authorizations, and related claim elements. Thorough knowledge of electronic health records, billing applications, clearing houses, payer portals, and electronic remittances. • • Ability to interpret and apply laws, contracts, payer guidance, and procedures to non-routine billing situations. • Ability to analyze accounts, claims, remittances, and supporting documentation and resolve discrepancies. • Ability to organize a high-volume workload and meet claim and appeal deadlines. • Ability to prepare billing procedures, crosswalks, correspondence, appeals, reconciliations, and reports. • Ability to explain billing requirements, train staff, and coordinate corrective action. Ability to establish and maintain effective working relationships with clients, staff, payers, vendors, and government agencies. • • Sound judgment, integrity, tact, and discretion in handling protected health, behavioral-health, and financial information. • Physical condition commensurate with the demands of the position.