Authorization & Billing Support Specialist, Senior

Authorization & Billing Support Specialist, Senior - Stony Brook Psychiatric Associates, UFPC  

Location: Stony Brook, NY

Schedule: Full time

Days/Hours: Monday - Friday; 8:30 AM - 5 PM ; Hybrid

Pay: $24.15 - $30.18

Our compensation philosophy aims to provide marketable compensation programs and to compensate employees based on relevant experience and education. Individual compensation discussions begin during the hiring process and may occur during job review and promotional opportunities. Salaries vary depending on experience, education and current market for the position. Human Resources determines the external and internal equitable salary for each employee.  The above salary range (or hiring range) represents Stony Brook CPMP’s good faith and reasonable estimate of the range of possible compensation at the time of posting 

SUMMARY: Assist the Medical Coding Manager with the day-to-day operations of the coding unit.  This position will provide general administrative and clinical office support.  Acts as a liaison between patients and physicians regarding insurance policies and procedures.   

Job Responsibilities:

• Validate patient insurance.
• Appeal denials, write appeal letters giving medical necessity and provide medical records to support the appeal.
• Review Task Manager regularly, respond to denials and open encounters posted to Task Manager, make corrections.
• Administrate insurance websites, oversee passwords.
• Collect insurance referrals and prior authorization for testing and procedures. Authorize and manage Neuro Psychiatric Testing. Ensure the approvals for the authorizations are in the EMR and CERNER systems.
• Promote department goals by training team members on insurance policies.  Stay current on guidelines set by insurance.  Educate staff and providers on insurance policies.
• Act as a resource with regards to insurance and coding policies and procedures to both staff and providers.
• Act as liaison and problem solver between physician and staff with regards to coding and charge entry.
• Provide resolution to coding related issues based on industry coding best practices.
• Analyze, code and abstract information for the purpose of assigning and entering appropriate and consistent diagnoses and procedure codes for reimbursement.
• Resolve discrepancies on coding related issues.
• Analyze and understand reasons for denials.
• Document trends of denials to share with department, and provide in-service for continuous improvement.  This includes changes of internal system, carrier updates, functions, and duties & processes impacting billing cycles.
• Inform staff and self pays of UH financial aid applications and Medicaid applications.
• Ensure all data are accurately documented in the EMR and scanned into CERNER.
• Provide data to CPMP Patient Accounts as requested for patient inquiries.
• Initiate Source Document to add new CPT Codes to Patient Keeper and Cerner.
• Proactively identify and implement opportunities for process improvements.
• Attend meetings and all other duties as assigned.

Required Education & Qualifications:

• Associate’s degree; in lieu of degree, an additional 2 years of experience working in a physician practice or healthcare environment.
• Three (3) years of full-time experience working in a physician practice or healthcare environment.
• Knowledge of insurance verification/update, scheduling, assist with prior pre-authorization or obtaining referrals process experience.
• Strong organizational and communication skills (both verbal and written).
• Excellent attention to detail.
• Exceptional telephone etiquette.
• Proficient in Microsoft Office.

Preferred Qualifications:

• Bachelor’s Degree.
• EMR experience – Cerner/IDX.
• Experience with patient scheduling.

Physical Demands:

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. While performing the duties of this job, the employee is regularly required to communicate with patients, staff and medical providers. The employee must be able to exchange accurate information in these situations. This position is largely sedentary and requires the employee to remain stationary for a majority of the day. Any additional physical demands will be outlined and provided by management. 

The responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of CPMP. 

StaffCo is a Professional Employer Organization, commonly referred to as a PEO, duly organized and registered under the New York Professional Employer Organization law. StaffCo and SUNY have entered into a professional employer agreement under which StaffCo is the employer of Stony Brook Clinical Practice Management Plan employees and responsible for all aspects of employment, including hirings, promotions, disciplines, terminations, the day-to-day direction and supervision of work, as well as labor relations and collective bargaining. StaffCo is fully responsible for providing all payroll and human resources services, including the payment of wages, collecting and reporting payroll taxes and maintaining any and all employee benefits.  SUNY Stony Brook Hospital is responsible for the operation of the hospital and provision of health care and is the co-employer as is necessary to conduct its responsibilities and for related licensure, regulatory or statutory requirements and obligations.    

Given StaffCo’s employment responsibilities, it is deemed the “employer” for employment and labor law purposes.  Thus, the employees are private sector employees of StaffCo, not public sector employees of SUNY.  The private sector nature of the StaffCo employees has been approved by NYS Civil Service and upheld in a decision by the US National Labor Relations Board. 

CPMP provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, gender identity or expression, or any other legally protected status.  This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall and transfer, leaves of absence, compensation and training.

CPMP expressly prohibits any form of workplace harassment based on race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, gender identity, or any other legally protected status.  Improper interference with the ability of CPMP’s employees to perform their job duties may result in discipline up to and including discharge.