NC Department of Health and Human Services · 4 hours ago
EI Program Billing Reimbursement Specialist
Wake County, NC
Full-time
Onsite
Mid Level
$59K/yr - $81K/yr
3+ years expThe North Carolina Department of Health and Human Services is one of the largest agencies in the state, focused on ensuring the health and well-being of all residents. They are seeking an EI Program Billing Reimbursement Specialist to lead project management, provide technical assistance, and analyze billing systems to support compliance and performance goals.
Health Care
Responsibilities
Project Management -- leads and/or participates in work groups or projects. Obtains authorization and commitment and demonstrates business need and project feasibility. Works with staff from both CDSAs and other organizations, as needed in planning and coordinating projects and meetings. Attends meetings as assigned, completes assignments and prepares/submits meeting summary
Data Review/oversight -- analyzes operations and reviews reports, recommendations, and justifications to ensure that planned activities support both EI Branch and CDSA staff in the achievement of compliance and performance goals and expectations. Reviews and evaluates information on service delivery system methods, billing systems, outputs, and activities to identify gaps in resources and recommend improvements. Works with program staff in determining trends and resolving technical problems. Assists with developing rules, policy and procedures in Medicaid, private insurance, financial and administrative areas
Technical Assistance -- leads and participates in program planning, development, and implementation, specifically in regard to technical assistance and training needs of both the EI Section and CDSA staff in administrative, financial and funding sources, including Medicaid Direct, Managed Care Organizations, and private insurance. Serves as a liasion between the EI Section and Medicaid. Creates and implements steps for the planning, development and implementation of technical assistance for the statewide IDEA, Part C program and specific Medicaid funding and billing requirements. Participates in the development and delivery of technical assistance in writing, in person, and through webinars. Works with EI Section staff and others to develop and implement effective techniques for evaluating technical assistance and training to CDSAs
Other duties as assigned
Qualification
Required
Demonstrated experience interpreting and applying Medicaid, Managed Care Organization (MCO), and private insurance reimbursement policies, evidenced by providing billing or reimbursement guidance, resolving coverage or claims issues, interpreting third-party payor standards, and supporting billing compliance activities within public health, human services, or healthcare programs
Demonstrated experience providing formal technical assistance, consultation, and training related to billing practices, reimbursement systems, and financial reporting, evidenced by developing written guidance, conducting trainings or webinars, consulting with providers or agencies, and serving as a liaison with Medicaid, MCOs, or managed care entities
Demonstrated experience interpreting and applying administrative, fiscal, and compliance policies and procedures, evidenced by authoring or maintaining procedures, responding to formal policy inquiries, participating in fiscal or compliance monitoring, and supporting the development or revision of billing, reimbursement, or financial policies
Demonstrated experience participating in program planning, evaluation, quality assurance, or compliance monitoring activities, evidenced by involvement in audits, monitoring reviews, corrective action planning, performance tracking, or quality improvement initiatives
Demonstrated experience analyzing programmatic and fiscal data to support billing oversight, compliance, and decision-making, evidenced by reviewing utilization, reimbursement, or expenditure data; identifying trends, gaps, or variances; preparing leadership or ad-hoc reports; and applying data findings to improve reimbursement processes
Bachelor's degree from an appropriately accredited institution and three (3) years progressively responsible experience related to the area of assignment; or an equivalent combination of training and experience
Preferred
Experience with Part C El program
Experience with Medicaid and private insurance coding using ICD-10 and reimbursement practices
Experience collecting and analyzing fiscal data
Knowledge of IDEA, privacy, confidentiality laws and regulations on both federal and state levels
Company
NC Department of Health and Human Services
The Department of Health and Human Services manages the delivery of health- and human-related services for all North Carolinians.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Erin Matteson
Chief Financial Officer, Opportunity and Well-being
Jean M. Sandaire
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