Newark, NJ • On-site, Remote
Job description
Billing Specialist will support our financial and program leadership and staff in the development, implementation, and management of Medicaid billing processes for housing support services. The Billing Specialist will ensure compliance with Medicaid guidelines, manage service authorization and claim submissions, and work closely with internal teams to improve billing accuracy and efficiency. This role will collaborate with various departments to implement CHNJ's Medicaid billing system, train staff, and ensure financial sustainability
Duties and responsibilities
Medicaid Billing Management:
Process, submit, and track Medicaid service authorizations and claims for housing-related services in compliance with Medicaid rules and regulations.
Ensure timely and accurate claims submission and follow-up on denied or underpaid claims.
Liaise with NJ Family Care and Managed Care Organizations (MCOs) to resolve claim discrepancies.
Coding and Documentation Management:
Review client records, including case management and housing support services documentation, to ensure appropriate Medicaid coding and compliance.
Responsible for timely and accurate service documentation in HMIS
Coordinate with program leadership and the Associate Director of Quality Improvement to ensure all documentation meets Medicaid requirements.
Claims Follow-up and Issue Resolution:
Monitor the status of Medicaid claims, follow up on unresolved claims, and ensure proper reprocessing where necessary.
Resolve billing issues by identifying discrepancies and ensuring all claims are paid correctly.
Train and support staff on Medicaid billing requirements, coding systems (CPT, ICD-10, HCPCS), and documentation protocols.
Provide ongoing guidance to staff on billing processes to ensure compliance.
Support and collaborate with program staff in completing documentation for service approvals and renewals.
Attend and participate in trainings/meetings/office hours offered by MCOs, HMIS, and the Camden Coalition
Billing and Compliance Reporting:
Generate monthly billing reports, track key performance indicators (KPIs), and identify trends in claim denials or delays.
Support internal audits and reporting to monitor billing performance and compliance with Medicaid regulations.
Medicaid Billing System Development:
Development of Billing Policies and Procedures:
Help create and update Medicaid billing policies, procedures, and compliance guidelines to align with federal and state regulations.
Ensure all staff understand and follow Medicaid billing practices.
Communicate up-to-date changes in Medicaid rules.
Monitoring, Reporting, and Continuous Improvement:
Conduct regular audits of Medicaid billing practices to ensure accuracy and compliance.
Use performance reports and audit results to implement process improvements in billing workflows, documentation standards, and staff training.
Compliance with Medicaid Regulations:
Stay updated on Medicaid policy changes and ensure that CHNJ's billing practices comply with all federal and state Medicaid regulations.
Monitor and ensure that Medicaid billing activities remain in full compliance with applicable rules and guidelines.
Integration with Grant Billing:
The Billing Specialist will play a key role in preventing duplication of billing between Medicaid and other grants. The Billing Specialist will collaborate with financial and program teams to establish clear protocols for cross-referencing Medicaid claims and grant invoices.
The Billing Specialist will develop a comprehensive reconciliation process to regularly compare billing records for Medicaid services with grant records to identify potential discrepancies. The Billing Specialist will engage in ongoing communication with the managers of other grants to stay informed about the scope and nature of services covered by those grants.
To maintain accuracy and transparency, the Billing Specialist will work with the Controller to conduct regular internal audits, reviewing Medicaid and grant billing records.
Assists with fundraising activities and special events which may be conducted outside the employee's normal work schedule.
Required to check company e-mail daily.
All other duties assigned by management staff
This position may be permitted the option to be placed on a hybrid office/remote schedule in the future based on performance.
Work Schedule: Monday thru Friday 9:00 AM -5:00 PM
