Service Fee Supervisor; 9161-385-A

For 125 years, Catholic Charities Brooklyn and Queens has been providing quality social services to the neighborhoods of Brooklyn and Queens, and currently offers 160-plus programs and services for children, youth, adults, seniors, and those struggling with mental illness. 
STATEMENT OF THE JOB:
Under the direct supervision of the Service Fee Manager, the Service Fee Supervisor works with Netsmart’s Revenue Cycle Management (RCM) to provide a broad suite of business office services to enhance revenue collection and timely receipt of payments.  The billing service includes all insurance carriers; Medicaid, Medicare and Managed Care Organizations and Commercial Payers. Including, but not limited to generating reports, reconciling billing data with remittances and preparing spreadsheets to track follow-up process. This position contains the supervisory duties to review the work of the Assistant Fee Supervisor. Periodically training staff.
* Assist with 835 enrollments.
* Initiate claims appeal for all clinical denials (No Auth, Med Rec Req, Non-covered service, Medical Necessity, Coding, Non- credentialed location or provider). RCM will provide a list of denials that require client interaction to resolve denial.
* Implement proposed changes to workflow.
* Work self-pay balances through management of 3rd party collection vendor and process.
* Review delinquent self-pay clients with organization liaison for final disposition.
* Research and status Client refunds
* Print and mail Client and insurance refund checks.
* Provide Netsmart with access to hospital or external systems for retrieval of demographic and clinical data as needed to work claims.
* Additional reporting needs or custom reporting request should be submitted through normal processes with Netsmart Managed Services. Specifications and design will be accommodated in the scope of those services.
* Communicate any needed adjustments to RCM.
* Complete applicable credentialing portions of the contracting process
* Contract rate negotiations
* Initial CAQH Provider Enrollment
* Provide Netsmart with updated provider attrition numbers.
* Assist client in the completion of payer enrollment agreements.  Client will be required to sign enrollment forms (Signee must be registered with the payer).  Client may be required to enroll through the payer portal – client login credentials may be required.
* Submit enrollment agreements to payers.
* Track the payer agreements for approval.
* Make necessary configurations to Care Record
* Generate 837 files for testing.
* Identify clearinghouse edits / rejections (Responsible for configuring Care Record to accommodate edits)
The following tasks will be performed Daily:
* Review and resolve as possible discrepancies/under payments.
* Ensure 80% of remits delivered through 835.
* Deposit time-of-service into bank account
* Deposit EFTs and check payments into bank account.
* Reconcile EFTs and check payments received against bank payments posted.
* Provide timely response and request to liaison regarding additional information to resolve delinquent insurance claims.

The following tasks will be performed Weekly:
* Research and Reporting of unbilled entries
* Reviews detailed listing of claims deemed uncollectable by RCM and approves write-off or requests additional information.
* Assist Netsmart with access to clinical or program managers that can assist with the following possible issues:
Documentation required for claims appeal for all clinical denials (No Auth, Med Rec Req, Non-covered service, Medical Necessity, Coding, Non-credentialed location or provider)
* Assist Netsmart with implement proposed changes to workflow to decrease denials 
QUALIFICATIONS:
* Associates degree in Business/Finance/Related Field is preferred or Billing Certification with High School Diploma and an additional 2 years’ experience.   
* 7 years of progressive work experience in related field.  
* Experience working with Medicaid, Medicare and Managed Care. 
* Experience with Electronic billing software, Netsmart preferred.
* Ability to effectively communicate and train staff in billing functions and processes.  
* May be required to lift approximately 10 lbs. 
* Able to travel throughout the five boroughs as needed. 
BENEFITS:
We offer competitive salary and excellent benefits including:
* Generous time off (Vacation/ Personal Days/ Sick Days/ Paid Holidays annually)
* Medical,
* Dental
* Vision
* Retirement Savings with Agency Match
* Transit
* Flexible Spending Account 
* Life insurance
* Public Loan Forgiveness Qualified Employer 
* Training Series and other additional voluntary benefits.
 
For more information on our organization, please visit our website at:
www.ccbq.org EOE/AA.