Required Qualifications (as evidenced on attached Resume): Associates degree (foreign equivalent or higher). In lieu of degree, two (2) years of full time experience in a medical setting. Four (4) years of full time experience working in a medical and/or office setting. Knowledge of medical terminology, previous medical claims processing experience, and proficiency with Word and Excel.
Medical coding certification. Experience with Electronic Medical Records (EMR). Experience with an electronic billing system(s). Experience with Patient Keeper billing system. Knowledge of Worker's compensation process. Knowledge of IDX (scheduling system). Familiarity with World Trade Center Health Program (WTCHP). Familiarity with HIPAA.
Brief Description of Duties: The successful candidate must possess excellent organizational and communication skills. S/he should have a strong sense of responsibility and initiative, use sound judgment I making decisions, and have the ability to work independently under minimal supervision. S/he will be responsible for assisting the Claims Manager with the following duties:
Verifying accuracy, completeness and compliance with WTCHP guidelines. Validating and releasing both internal and external claims.
Complete routine authorizations for procedures required by external providers.
Research claims for payment in the Referral database, Authorization log and EMR. Confirm patient was WTC-referred.
Confirm receipt of office notes and/or test results, and other criteria as determined by the program such as certifications, correct coding, operative reports, etc.
Facilitate resolution of claims received that are not complete and/or do not comply with the Program guidelines. Send denial letters to providers when necessary.
Assist in the resolution of billing issues, i.e., WTCHP program billed in error, program billed as secondary insurance, out of network providers billed in error.
Ensure that vendors and providers are in the WTCHP network, when necessary. Work with Claims Manager to have vendors and/or providers added to the network.
Attend a monthly offsite meeting (Patient Keeper billing) in either East Setauket or Stony Brook.
Assist in the education of program guidelines and claims processes to external providers.
Assist in the maintenance of the comprehensive claims process, i.e. through input of suggestions for quality improvement or revisions to best practices.
Other duties as assigned.
The Research Foundation of SUNY is a private educational corporation. Employment is subject to the Research Foundation policies and procedures, sponsor guidelines and the availability of funding. FLSA Nonexempt position, eligible for the overtime provisions of the FLSA.
Long Island's premier academic medical center, Stony Brook Medicine represents Stony Brook University's entire medical enterprise and integrates all of Stony Brook's health-related initiatives: education, research and patient care. It encompasses Stony Brook University Hospital, Stony Brook Children's Hospital, the six Health Sciences schools — Dental Medicine, Health Technology and Management, Pharmaceutical Sciences, Medicine, Nursing and Social Welfare — as well as the major centers and institutes, programs and more than 50 community-based healthcare settings throughout Suffolk County. With 603 beds, Stony Brook University Hospital serves as Suffolk County's only tertiary care center and Regional Trauma Center. Stony Brook Children's, with more than 180 pediatric specialists in 30 specialties, offers the most advanced pediatric specialty care in the region.
Stony Brook University/Research is an Equal Opportunity /Affirmative Action Employer. We encourage all to apply including individuals with disabilities and protected veterans.
If you need a disability related accommodation, please call the University Human Resource Services Department at (631) 632- 6161 or the University Hospital Human Resources Department at (631) 444-4700. In accordance with the Title II Crime Awareness and Security Act, a copy of our crime statistics is available upon request by calling (631) 632- 6350. It can also be viewed on line at the University Police website at http://www.stonybrook.edu/police .
Department/Hiring Area: Medicine-WTCHP-The Research Foundation for The State University of New York at Stony Brook
Schedule: Full-time Shift: Day Shift Shift Hours: 8:00 a.m. - 4:00 p.m. Pass Days: Sat, Sun
Posting Start Date: May 15, 2019
Posting End Date: May 30, 2019, 3:59:00 AM
Salary: Commensurate with experience within the range of $38,000 - $47,000.
Salary Grade: N7
Appointment Type: Temporary
Internal Number: 1901406
About Stony Brook University
FROM ITS BEGINNINGS A HALF-CENTURY AGO, STONY BROOK UNIVERSITY HAS BEEN CHARACTERIZED by innovation, energy and progress, transforming the lives of people who earn degrees, work and make groundbreaking discoveries here. A dramatic trajectory of growth has turned what was once a small teacher preparation college into an internationally recognized research institution that is changing the world.