For 125 years, Catholic Charities Brooklyn and Queens has been providing quality social services to the neighborhoods of Brooklyn and Queens, and currently offers 160-plus programs and services for children, youth, adults, seniors, and those struggling with mental illness. STATEMENT OF THE JOB:Under the direct supervision of the Assistant Budget Director II, the Service Fee Manager works with Netsmart’s Revenue Cycle Management (RCM) to provide a broad suite of business office services to enhance revenue collection and timely receipt of payments. The billing service includes all insurance carriers; Medicaid, Medicare and Managed Care Organizations and Commercial Payers. Including, but not limited to generating reports, reconciling billing data with remittances and preparing spreadsheets to track follow-up process. This position contains the supervisory duties: reviewing the work of the Service Fee Supervisor and Assistant Service Fee Supervisor. Periodically training staff. The Service Fee Manager will be responsible for leading team meetings and recommending ongoing improvements to further enhance revenue cycle performance in the department.* Provide unique use credentials to Netsmart associates for Access to: Care Record, FISS/DDE to client provider numbers, all non-Medicare payers included in RCM scope, Clearinghouse, remittance advice and/or 835 payment files, payer contracts and client liaison to address clinical items.* Review current billing, A/R and cash posting standard operating procedures with Netsmart onboarding manger.* Review and approve Netsmart RCM standard operating procedure documents.* Request add/change to payer plan setup.* Complete system configuration for add/change payer setup.* Request add/change to charge configuration including but not limited to: Service codes Service code fees HCPCS codes, Revenue codes CPT Codes* Complete system configuration for add/change charge configuration.* Request system configuration changes related to regulatory releases.* Complete requested system configuration for regulatory releases* Assist Netsmart with access to clinical or program managers that can assist with the following possible issues: charge entry errors, provide clinical documentation as requested, missing or errors with diagnosis and coding errors * Review billing edits and errors that require clinical data * Assist with any EDI enrollment requirements * Assist with 835 enrollments.* Initiate claims appeal for all clinical denials (No Auth, Med Rec Req, Non-covered service, Medical Necessity, Coding, Non- credentialed location or provider). RCM will provide a list of denials that require client interaction to resolve denial.* Implement proposed changes to workflow.* Work self-pay balances through management of 3rd party collection vendor and process.* Review delinquent self-pay clients with organization liaison for final disposition.* Research and status Client refunds* Print and mail Client and insurance refund checks.* Provide Netsmart with access to hospital or external systems for retrieval of demographic and clinical data as needed to work claims.* Additional reporting needs or custom reporting request should be submitted through normal processes with Netsmart Managed Services. Specifications and design will be accommodated in the scope of those services.* Communicate any needed adjustments to RCM.* Complete applicable credentialing portions of the contracting process* Contract rate negotiations* Initial CAQH Provider Enrollment* Provide Netsmart with updated provider attrition numbers.* Assist client in the completion of payer enrollment agreements. Client will be required to sign enrollment forms (Signee must be registered with the payer). Client may be required to enroll through the payer portal – client login credentials may be required.* Submit enrollment agreements to payers.* Track the payer agreements for approval.* Make necessary configurations to Care Record* Generate 837 files for testing.* Identify clearinghouse edits / rejections (Client is responsible for configuring Care Record to accommodate edits)The following tasks will be performed Daily:* Review and resolve as possible discrepancies/under payments.* Ensure 80% of remits delivered through 835.* Deposit time-of-service into bank account* Deposit EFTs and check payments into bank account.* Reconcile EFTs and check payments received against bank payments posted.* Provide timely response and request to liaison regarding additional information to resolve delinquent insurance claims.The following tasks will be performed Weekly:* Research and Reporting on unbilled entries* Reviews detailed listing of claims deemed uncollectable by RCM and approves write-off or requests additional information.* Assist Netsmart with access to clinical or program managers that can assist with the following possible issues:Documentation required for claims appeal for all clinical denials (No Auth, Med Rec Req, Non-covered service, Medical Necessity, Coding, Non-credentialed location or provider)" * Assist Netsmart with implement proposed changes to workflow to decrease denials The following tasks will be performed Monthly:* Generate and share Net Revenue templates for Gross to Net Revenue calculation.* Balance revenue to general ledger* Validate balancing.* Run GL Extract* Close Accounting Period* Review and approve delinquent self-pay clients for final disposition * Provide timely response to Netsmart regarding additional information to resolve delinquent insurance claims * Provide Netsmart with demographic and clinical data as needed to work claims * Provide Netsmart with approval for write-off related to the detailed listing of claims deemed uncollectable by RCM QUALIFICATIONS:* BA/BS degree in Business/Finance/Related Field is preferred or Billing Certification with High School Diploma and an additional 2 years’ experience. * 8 years of work experience in related field is required. * Experience working with Medicaid, Medicare and Managed Care. * Experience with Electronic billing software, Netsmart preferred.* Ability to effectively communicate and train staff in billing functions and processes. * May be required to lift approximately 10 lbs. * Able to travel throughout the five boroughs as needed. BENEFITS:We offer competitive salary and excellent benefits including:* Generous time off (Vacation/ Personal Days/ Sick Days/ Paid Holidays annually)* Medical,* Dental* Vision* Retirement Savings with Agency Match* Transit* Flexible Spending Account * Life insurance* Public Loan Forgiveness Qualified Employer * Training Series and other additional voluntary benefits. For more information on our organization, please visit our website at:www.ccbq.org EOE/AA.