Billing & Credentialing Specialist

Open Door Family Medical Center provides health care and wellness programs to individuals and families in need throughout Westchester, Putnam and Ulster Counties.

A pioneer Federally Qualified Health Center, Open Door provides more than 300,000 patient visits annually and serves nearly 60,000 individual patients who might not otherwise have access.

Open Door offers integrated services and a holistic approach to building healthier communities. Primary medical care, dental care, integrated behavioral health care, clinical nutrition, wellness programs, and chronic disease management are the foundation of its clinical programs.

Open Door is seeking a Billing & Credentialing Specialist located out of our Ossining, NY headquarters. The aim of the New York State Department of Health (NYSDOH) Cancer Services Program (CSP) is to improve access to, and utilization of, high quality, guideline-concordant breast, cervical and colorectal cancer screening services for residents of New York State (NYS).

Responsibilities of the Billing & Credentialing Specialist include managing the Direct Provider Payment process and the contracted provider credentialing process.

Responsibilities

BILLING DUTIES

• Manages the Direct Provider Payment (DPP) process to ensure that all invoicing and payment workflows are adhered to and in compliance with NYSDOH policies and guidelines
• Maintains the credentialing workbook and credentialed provider agreements ensuring contacts are up to date
• Serves as a resource for the Pay to Contacts and other contractor fiscal staff (as appropriate) and assists with guiding them through the DPP process, troubleshooting and responding to questions
• Monitors the DPP process, reconciles claims and payments) to identify issues and proactively develop / implement solutions;

tracks identified issues from start to finish

• Communicates with clients to provide updates on billing issues
• Prepares, analyzes, and maintains reports
• Maintains up to date expertise and knowledge of the DPP process and related CSP systems and workflows

CREDENTIALING DUTIES

• Implements the NYSDOH CSP provider credentialing process, including coordinating with the NYSDOH and maintaining all required documentation
• Obtains provider agreements
• Requests new or revised site codes from the NYSDOH and assists providers with troubleshooting site code matters

GENERAL DUTIES

• Collaborates with supervisor to ensure that all required workplan activities are implemented in compliance with the NYSDOH contract
• Supports the CSP department’s purchasing process and invoice management
• Collaborates with supervisor to adjust workflows and address issues
• Assists with chart / documentation reviews to ensure compliance with policies and procedures; provides additional training if gaps in documentation are identified
• Collaborates with NYSDOH staff
• Collaborates with the Clinical Care Coordinator and other program staff
• Participates in the training of new staff members and provides feedback to supervisor on 30-60-90 day goal achievement
• Other duties as assigned

COMMUNICATION

• Represents CSP within the greater community to raise awareness of the program
• Informs the Director, SBHC and HITCH Operations of any problems that may affect quality and standards of services
• Fosters good communication within the program, and with program partners and the community
• Demonstrates ability to function in a culturally sensitive manner
• Communicates with partner and provider staff and clients in a clear, professional and timely manner, whether via phone, email, telephone encounter, fax or other means

PLANNING

Attends staff and other organizational meetings, as designated, to ascertain and contribute to short- and long-range plans, programs, and goals within areas of responsibility

Participates in staff development programs, educational activities, seminars, and training opportunities

COMPLIANCE MANAGEMENT

Maintains client confidentiality at all times per the Health Insurance Portability and Accountability Act (HIPAA)

Prepares and maintains documentation in compliance with policies and procedures and applicable city, state, and federal laws

Meets annual mandatory training requirements

Qualifications

EDUCATION

Bachelors degree required

EXPERIENCE

• Experience with or education / training in billing, credentialing, accounting / finances required
• Experience with community / health / social service organizations required, experience within the Cancer Services Program preferred
• Experience with databases / data entry is required, experience with electronic medical records is preferred
• Experience with EXCEL is required

SKILLS

• Fluent in English, fluent in Spanish preferred
• Advanced computer use, including Microsoft Office applications, especially EXCEL
• Strong mathematical and analytical skills
• Strong interpersonal skills including excellent active listening and clear oral communication skills; engaging, warm and caring personality
• Works effectively as a member of a team
• Strong writing and reading abilities
• Effective in problem solving and exhibits excellent judgment and the ability to prioritize
• Strong customer service, client-centered orientation; collaborative; empathetic and driven to assist clients; passionate about providing high quality care to low-income, under-served individuals and those lacking access to needed services
• Culturally competent / sensitive (racial, ethnic, linguistic, LGBTQ+, physical ability, etc.) and committed to providing inclusive, non-biased services
• Highly organized and self-directed, able to multi-task; understands and follows detailed instructions; flexible and exhibits the ability to adapt as situations evolve

ADDITIONAL REQUIREMENTS

Must have a driver’s license valid in New York State and occasional / as needed access to car

There are many fantastic benefits to a career at Open Door Family Medical Centers. In addition to working to effect positive change in the health and lives of thousands of residents in our communities, Open Door offers its employees a stimulating, diverse and team-based work environment with comprehensive benefits including medical, dental, life insurance, flexible spending accounts, 401(k), generous paid time off, and educational assistance.

Aside from excellent benefits, we offer a competitive salary and annual bonuses based on organizational and individual objectives.

Open Door is an Equal Opportunity Employer