At Healthy Alliance, our purpose is to improve health and empower the underserved. Every community has its own needs, affecting the health of those who live, learn, work, and play within them. Our network brings together organizations, big and small, to coordinate and collaborate so that all communities have reliable access to the resources they need. Why? Because every New Yorker deserves the same opportunity to be healthy.

Designated as the Social Care Network (SCN) Lead Entity for the Capital Region, Central NY, and North Country under New York’s 1115 Waiver Amendment’s SCN & Health-Related Social Needs (HRSN) Program, we are responsible for ensuring that there is a seamless, consistent end-to-end process for HRSN screening, navigation, and the delivery of HRSN and other services to thousands of Medicaid Members. Transformative in nature, this novel Program will further sustain our mission of advancing health equity within and across historically marginalized communities. 

As a 2019-24 Albany Business Review’s Best Places to Work and a 2021-2024 Modern Healthcare’s Best Places to Work in Health Care award recipient, we strive to maintain a culture wherein high-performing, mission-driven team members collectively work toward better health for all. Dedicated to promoting a culture built upon autonomy, mastery, and purpose, we believe our differences in strengths and perspectives play an integral role in propelling us forward, while our core values ground us, serving as the common thread that unites our team.

Why You Should Join Healthy Alliance

We offer amenities, professional development opportunities, events, and programming that support the interests of our teams while expanding and enriching our culture. Some of the benefits you can expect when you join Healthy Alliance include:

• Competitive compensation package 
• Comprehensive insurance benefits available the 1st of the month after hire, including but not limited to medical, dental and      vision, group short-term disability and life insurance with buy-up options, flexible spending and HSA company-contributed accounts, and more
• 401K with a company match
• Unlimited paid time off after 90 days of employment
• Company-sponsored training and certification opportunities
• Remote employer with flexible work schedules
• A workplace that values safety, respect, employee engagement, recognition, and diversity
• Salary range: $41,700 - $48,000 per year, commensurate with experience

Who You Are

The Billing Specialist will prepare and execute billing and collection processes for Healthy Alliance by reviewing and submitting billing via the Unite Us platform and MillinPro RCM application.  

The above statements are intended to describe the general nature and level of work being performed by persons assigned to this classification. They are not to be construed as an exhaustive list of duties assigned. Responsibilities and activities may change at any time with or without notice.

What You’ll Do 

• Review for accuracy and reconcile billing in MillinPro and Unite Us with the Finance Liaison and RCM Director. 
• Verify prior authorizations and eligibility in collaboration with the Eligibility Specialist. 
• Submit invoices and batches electronically for the Social Care Network (SCN) & Health-Related Social Needs (HRSN) Program’s billable services and all other billable services, ensuring timely submission and completeness. 
• Monitor partner SCN & HRSN Program billable claims and all other claims for pends/denials requiring follow-up, working with the Finance Liaison to resolve claim issues and re-bills as needed. 
• Review remittance advice with the RCM Director and identify differences between billed and collected amounts to resolve, address, and collect all unpaid accounts. 
• Collaborate with the Finance Liaison and RCM Director to meet partner needs and ensure positive partner experience.
• Review and reconcile PMPM payments in MillinPro in collaboration with the RCM Director. 
• Identify partner needs and connect to appropriate Healthy Alliance stakeholders. 
• Use Healthy Alliance tools and resources to inform the Finance Liaison of partner communication needs. 
• Enter, maintain, and update information regarding community members, fee schedules, and other relevant information necessary to complete billing. 
• Exercise discretion and professional judgement to maintain project-specific timelines and communicate project expectations and timelines with internal and external stakeholders. 
• Maintain current knowledge and understanding of Medicaid and local transformation, including Waiver programs, Triple Aim, and value-based purchasing (VBP). 
• Remain current in all required trainings. 
• Be clear and maintain an acceptable record under the Medicaid Fraud & Abuse clearance process. 

Education 

• Associate degree in a related field or equivalent experience such as accounting or business-related fields. Equivalent work experience in government/health payor billing may be considered in lieu of degree in a related field or equivalent experience in business-related field. Certified billing & coding preferred.  

Professional Work Experience

• Minimum of 2+ years health care claims billing experience required to include Medicaid, Medicaid Managed Care, and Medicare billing with familiarity with ePACES/eMedNY and RCM systems.
   

Skills, Knowledge, and Abilities   

• Excellent written and verbal communication skills. 
• Strong working knowledge of Office 365 Suites. 
• Ability to manage multiple detailed projects simultaneously and adjust as needed. 
• Ability to identify the source of a problem and propose a timely solution. 
• Commitment to the values of diversity, equity, and inclusion. 
• Strong community awareness and astuteness. 
• Embody Healthy Alliance’s vision, mission, and goals. 

This job description is not designed to cover or contain a comprehensive listing of task activities and/or duties that are required of the employee for this job. Responsibilities and activities may change at any time with or without notice.

Offers of employment are contingent upon a satisfactory background investigation including OIG List of Excluded Individuals and Entities (LEIE) and state Medicaid exclusion lists. In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States.

Physical requirements

This position involves sedentary work that primarily involves sitting/standing, use of typical office equipment such as a computer, laptop, and cell phone. May include light work that includes moving objects up to 20 pounds independently or with assistance. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Equal Opportunity Employer

Healthy Alliance is an Equal Opportunity Employer and does not discriminate against any employee or applicant on the basis of age, ancestry, color, family or medical care leave, gender identity or expression, genetic information, marital status, medical condition, national origin, physical or mental disability, political affiliation, protected veteran status, race, religion, sex (including pregnancy), sexual orientation, or any other characteristic protected by applicable laws, regulations and ordinances. We adhere to these principles in all aspects of employment, including recruitment, hiring, training, compensation, promotion, benefits, social and recreational programs, and discipline.

If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to hr@healthyalliance.us

Privacy Requirement

This job function involves potential access/interaction with protected health information. Position will be required to abide by company policies and procedures that support federal, state and local HIPAA regulations. Any violations will be subject to company policy which includes disciplinary actions up to and including separation of employment. Healthy Alliance is an At-Will Employer