Prior Authorization Utilization Review Jobs in Rochester, NY

 Angels In Your Home, a New York State Licensed Home Care Services Agency (LHCSA), is seeking an experienced, detail-oriented Medical Biller / Accounts Receivable Specialist to join our administrative team.

The Medical Biller / Accounts Receivable Specialist plays an important role in ensuring the accurate and timely billing and collection of payments for home care services. This position is responsible for preparing and submitting claims, reviewing billing documentation, posting and reconciling payments, monitoring accounts receivable, and following claims through payment or resolution.

The ideal candidate will have prior experience with healthcare, Medicaid Managed Care, or home care billing and collections and understand the relationship between authorizations, scheduled and worked services, EVV documentation, claims submission, remittance, denials, and reimbursement.

This position works closely with internal billing, scheduling, intake, payroll, and clinical staff, as well as managed care plans, insurance representatives, and other payers, to identify and resolve billing issues and ensure services are billed accurately and in accordance with payer requirements.

• Prepare, review, and submit accurate and timely claims for home care services in accordance with payer requirements, agency procedures, and applicable billing regulations.
• Review authorizations, plans of care/service information, schedules, timesheets, EVV records, and other supporting documentation prior to billing to ensure services are billable and properly supported.
• Verify that billed units, dates of service, service codes, rates, authorizations, and caregiver/service documentation are accurate prior to claim submission.
• Monitor submitted claims through adjudication and payment.
• Post and reconcile payments, remittance information, adjustments, denials, and other account activity accurately and timely.
• Maintain and reconcile accounts receivable, including outstanding, unpaid, underpaid, denied, and rejected claims.
• Identify billing discrepancies and work with appropriate internal departments to obtain corrections or missing documentation.
• Research and resolve claim denials, rejections, underpayments, authorization discrepancies, and other reimbursement issues.
• Correct and resubmit claims when necessary and complete appropriate follow-up until claims are resolved.
• Communicate with Medicaid Managed Care Plans, insurance companies, payer representatives, and other funding sources regarding claim status, payment discrepancies, denials, authorizations, and billing corrections.
• Review payer remittance information and identify discrepancies between expected and actual reimbursement.
• Assist with collections and follow-up on outstanding balances and aged accounts receivable.
• Maintain accurate billing records, documentation, and supporting information in accordance with agency policy and payer requirements.
• Ensure billing practices comply with applicable Medicaid, managed care, EVV, payer, HIPAA, and agency requirements.
• Maintain confidentiality of patient, employee, payer, and agency information.
• Stay informed of payer updates, billing requirements, reimbursement changes, and process changes that may impact claim submission or payment.
• Work collaboratively with scheduling, intake, payroll, clinical, compliance, and administrative staff to resolve billing-related issues.
• Communicate clearly and professionally regarding missing documentation, authorization issues, claim corrections, and other matters affecting reimbursement.
• Assist with billing reports, account reconciliation, audits, and other billing or accounts receivable functions as assigned.

  Required Qualifications 

• Prior experience in medical billing, healthcare billing, home care billing, accounts receivable, or claims processing.
• Experience working with insurance claims, payer reimbursement, denials, collections, and accounts receivable.
• Strong understanding of the billing cycle from service documentation and claim submission through payment, denial resolution, and reconciliation.
• Strong analytical and problem-solving skills with excellent attention to detail.
• Ability to identify discrepancies involving documentation, schedules, authorizations, units, rates, payments, and claims.
• Ability to independently research billing issues and follow claims through resolution.
• Strong written and verbal communication skills.
• Ability to manage multiple priorities, meet billing deadlines, and maintain organized and accurate records.
• Proficiency with Microsoft Office, particularly Excel and Outlook.
• High school diploma or equivalent required.

  Preferred Qualifications 

• 2+ years of medical billing, healthcare billing, or accounts receivable experience preferred.
• Prior home care or LHCSA billing experience strongly preferred.
• Experience billing New York Medicaid Managed Care Plans strongly preferred.
• Knowledge of Medicaid, managed care authorizations, EVV, claim submission, remittance, denial management, and reimbursement processes.
• Experience with HHAeXchange strongly preferred.
• Experience with EDI/837 claims, electronic remittance/835 files, clearinghouses, or payer billing portals is a plus.
• Associate degree or additional education/training in medical billing, healthcare administration, accounting, or a related field preferred.