ADS Billing and Payment Specialist

Benefits:

• Dental insurance
• Health insurance
• Paid time off
• Tuition assistance
• Vision insurance

DePaul Community Resources seeks a Full-time (37.5 hours per workweek) ADS Billing and Payment Specialist in any DePaul location.

JOB SUMMARY:
The ADS Billing and Payment Specialist position supports the Finance Department and Operational staff in the Agency Directed Services (ADS) Division. This position is responsible for the daily billing and collections for ADS and associated payments to Caregivers. The ADS Billing and Payment Specialist will also play a critical role in managing the Medicaid/MCO service authorization process and maintaining accurate credentialing records for ADS within our organization. The ADS Billing and Payment Specialist will maintain all payable records for all Caregivers, as well.
The ADS Billing and Payment specialist must build relationships and work with all Finance team members, other DePaul staff at all levels of the organization, and multiple partner agencies and third-party payors of DePauls services.
This position is primarily remote work, with the occasional need to visit the assigned office for meetings as required.

SUPERVISION RECEIVED AND EXERCISED:
The ADS Billing and Payment Specialist reports directly to the Senior Accounting Specialist.

ESSENTIAL FUNCTIONS AND DUTIES:
This list is not an exhaustive & all-inclusive list of job responsibilities. The distribution of time allotted for any function or duty is subject to change with or without notice. Nothing in this job description restricts management's right to assign other responsibilities to this job or reassign them elsewhere at any time.

Service Authorization Management:

• Coordinate and facilitate the authorization process for services rendered to Medicaid and MCO beneficiaries.
• Collaborate with ADS Staff to gather necessary documentation for authorization requests.
• Monitor authorization timelines and ensure adherence to regulatory standards.
• Keep abreast of changes in Medicaid and MCO regulations and update internal processes accordingly.

Credentialing Oversight:

• Manage the ADS credentialing and re-credentialing processes for DePaul Community Resources in accordance with Medicaid and MCO regulations.
• Monitor and adapt to changes in Medicaid and MCO policies, procedures, and requirements related to credentialing.

Billing and Accounts Receivable Management:

• Collaborate and work cross-functionally with ADS Program staff to ensure billing is complete, accurate, and collectible.
• Complete / Upload all billing for ADS in Sage 100 biweekly.
• Ensure accurate and timely biweekly submission of applicable ADS billing to all third-party payers (Medicaid, MCOs, individual clients, etc.).
• Process all cash receipts in Sage 100 for ADS daily.
• Monitor Accounts Receivable and take necessary steps to collect outstanding balances.
• Work with all payers, including insurance carriers, other organizations, DePaul staff, and clients, to resolve billing issues promptly.
• Research any past-due balances, unpaid and underpaid; follow up on any denials of payment and determine a resolution that includes corrected claims, disputes, and appeals.
• Communicate with ADS staff regarding denials that require client intervention to receive reimbursement.

Accounts Payable Management (for Caregivers):

• Ensure all paperwork for ADS Caregivers regarding compensation is acquired and maintained in accordance with approved policies and procedures.
• Review EVV time punches for accuracy related to approved Service Authorizations and related scheduling.
• Present payment information to ADS leadership for review and approval prior to processing associated payments.
• Prepare and upload payment information for ADS Caregivers into Sage 100 on a bi-weekly basis.
• Work with DePaul Accounts Payable to ensure payments are made in accordance with the approved payment schedule for ADS Caregivers.

Communication and Collaboration:

• Act as the main point of contact for questions related to the billing or payment of services for ADS.
• Communicate effectively with internal teams and external agencies to resolve authorization or credentialing issues.
• Collaborate with other departments to streamline processes and improve efficiency in authorization and credentialing workflows, as well as associated billing and payments.

KNOWLEDGE, SKILLS, ABILITIES & OTHER CHARACTERISTICS REQUIRED:
Knowledge, skills, abilities, and other characteristics or KSAOs are attributes needed to perform a job that are demonstrated through qualifying training, education, and experience. This list is not an exhaustive & all-inclusive list of all KSAOs for this job.

Knowledge of:

• Healthcare terminology and Medicaid provider qualifications
• Virginia Waiver Management Systems (WaMS)
• Kepro/Atrezzo/Acentra portal
• Availity portal
• Virginia Medicaid Enterprise System (MES)
• Credentialing process for Virginia Medicaid Managed Care Organizations (MCOs)
• Service authorizations and insurance verifications
• Office and records administration techniques and procedures.
• Office procedures and spelling, grammar, punctuation, and arithmetic.
• The structure and content of the English language, including the meaning and spelling of words, rules of composition, and grammar.
• Microsoft Office Word, Excel, PowerPoint, Outlook, SharePoint, Teams, and virtual meeting applications such as Zoom.
• DePaul's policies, procedures, and standard practices and the rules and guidelines established by regulatory and governing agencies such as DBHDS (Department of Behavioral Health & Developmental Services), HCBS (Home Community Based Services, HSAG (Health Services Advisory Group), DSS (Department of Social Services, and DMAS (Department of Medical Assistance Services)
• Policies, procedures, and strategies that promote the safety and protection of people, data, and property.

Skill in/Ability to:

• Proficiency in using database systems and software for credentialing and authorization processes.
• Work independently and collaboratively in a fast-paced environment while maintaining accuracy and attention to detail.
• Complete required training as needed and assigned.
• Give full attention to what other people are saying, take time to understand the points being made, ask questions as appropriate, and not interrupt at inappropriate times.
• Demonstrate verbal and written communication and body language that conveys information, ideas, or inquiries effectively and concisely that purveys professional composure, emotional intelligence, thoughtfulness, patience, and respect amidst change, ambiguity, and within the daily trajectories of work.
• Operate standard office equipment such as telephone, calculator, printer, scanner, cellular phone, tablet, computer, postage machine, shredder.
• Demonstrate logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems.
• Collect and analyze data.
• Manage multiple priorities and complete assignments on time, accurately, and with attention to detail, and ensure a high-quality work product.
• Work collaboratively within a team environment and build strategic relations with coworkers, management, and community partners.
• Communicate effectively in both oral and written form.
• Develop objectives, evaluate effectiveness, and assess needs.
• Recognize, analyze, and problem-solve ambiguous or difficult situations and questions using critical thinking while maintaining professional composure.

Other Characteristics:

• Demonstrate self-awareness, ongoing self-evaluation, and a commitment to being part of a diverse, equitable, respectful, and inclusive workplace where all people are valued.
• Demonstrate professional composure in difficult and stressful situations.
• Demonstrate the FIRST (fairness, integrity, respect, safety, trust) values in the daily trajectories of work.
• Demonstrate professionalism regarding access to sensitive and confidential information related to employees, clients, and business records with no disclosure to others without needing to know.

MINIMUM REQUIREMENTS TO APPLY:

• High school diploma or G.E.D. required.
• Preferred education in Healthcare Administration, Human Services, or a related field, or equivalent work experience
• Experience working with Medicaid regulations, preferably in service authorization and credentialing.

WORK ENVIRONMENT:
The work environment characteristics described herein represent those an employee encounters while performing the position's essential functions. The employee regularly works in an office environment and occasionally in the field. Work is generally completed regularly during weekdays; however, daily work hours may vary. Completion of job duties outside of normally scheduled hours may be required. Work is subject to frequent interruptions, and noise levels are varied based on the work locations.

PHYSICAL REQUIREMENTS:
The physical demands described herein are representative of those that an employee in this position must meet, with or without reasonable accommodations, to perform the essential functions successfully. Physical activities required are finger dexterity necessary to operate equipment used in the position, effective communication, and seeing or hearing verbal cues. Walking for up to one-third of the time, sitting two-thirds or more of the time, standing for up to one-third of the time, bending from one-third to two-thirds of the time, stooping for up to one-third of the time, lifting/pushing/pulling no more than ten pounds is required. When accessing various locations, the incumbent must climb stairs and ramps. This position requires driving approximately ten percent of the employee's working time to various locations. Public transportation may not be available. Individuals needing reasonable accommodations should speak with their immediate supervisor/hiring manager.

SPECIAL REQUIREMENTS AND QUALIFICATIONS:
Successful completion (per DePaul's policies) of a Motor Vehicle Record, Criminal and Child Protective Services Background Report, and Drug Test is required. An unsatisfactory result of any of these tests will terminate the application process.

NOTE:
This description provides information regarding the essential functions of the designated job and the general nature and level of work associated with the job. It should not be interpreted to describe all the duties whose performance may be required of such employees or be used to limit the nature and extent of assignments such an individual may be given.

Compensation depends on qualifications and experience.

DePaul is committed to diversity, equity, and inclusion and is an equal-opportunity employer.
E-Verify Participant.