Job Description

Now Hiring: Billing Specialist
Location: In Person - New Hyde Park, NY
**This position is Fully Onsite Monday–Friday, 9:00 AM–5:00 PM**

Liaise between Extended Home Care clinical staff and all Managed Care contracts to facilitate the timely receipt and processing of authorizations for patient services. Provide supervision and oversight to the HMO Department and HMO Specialists in effectively managing authorization requests and denials.

QUALIFICATIONS:
• Associate degree or five years relevant work experience required; Bachelor’s Degree preferred
• Minimum of two years’ experience working with HMOs and/or Commercial Health Insurances and knowledge of Managed Care regulations
• Previous experience working in a supervisory capacity preferred
• Ability to work cooperatively with others, support team decisions, and solve problems independently
• Ability to manage a team and oversee daily assignments and performance
• Strong verbal and written communication skills
• Strong organizational and prioritization skills for processing authorizations and clinical reports
• Proficiency in Outlook, Excel, Word, and related applications
• Familiarity with McKesson or other EMR platforms

RESPONSIBILITIES:
• Collaborate with EHC Case Managers/COC’s and Clinical Managers to formulate service requests
• Obtain and maintain authorizations for the HMO Department
• Create formal authorization requests using clinical documentation (visit notes, orders, SOC notes, etc.)
• Generate and submit Managed Care Request Forms via Horizon/McKesson in a timely manner
• Liaise with Managed Care and HMO contracts regarding approvals and denials
• Handle inbound/outbound calls with payers regarding verbal authorizations
• Enter authorization determinations (verbal, electronic, fax) into Horizon/McKesson
• Verify authorization details including numbers, timeframes, and approved/denied services
• Audit visits completed vs. approved visits and request additional services when needed
• Organize pending authorizations by payer, urgency, and timelines
• Follow up on outstanding authorization requests
• Document authorization status and delays in McKesson
• Notify Case Managers of authorization updates via system, email, and calendar
• Assist Billing with authorization discrepancies and monthly reconciliations
• Maintain updated payer contact lists and build strong working relationships
• Supervise HMO Specialists and provide coverage as needed
• Resolve day-to-day operational issues within the HMO Department
• Coordinate staffing, assign workloads, and monitor productivity/quality
• Establish workflows, schedules, and improve efficiency
• Prepare and submit weekly/monthly reports to DPS
• Perform additional duties as assigned
• Ensure compliance with corporate policies and report any suspected violations

POSITION BENEFITS:
• Health, Dental, Vision
• 401k + Company Match
• Paid Holidays
• PTO Package
• Paid Orientation
• Employee Referral Program

SALARY:
$24–$28/HR