Job Title: Social Care Network (SCN) Claims & Billing Manager

Reports To: Director of Finance & Contracting

Project Summary:

The New York State Department of Health has established Social Care Networks (SCNs) as part of the 1115 Waiver Demonstration Amendment, and Forward Leading IPA (FLIPA) is the SCN Lead for the Finger Lakes Region. This region is comprised of 14 counties, including Allegany, Cayuga, Chemung, Genesee, Livingston, Monroe, Ontario, Orleans, Schuyler, Seneca, Steuben, Wayne, Wyoming, and Yates. The SCN’s aim is to enhance the delivery of social care services to Medicaid members by coordinating efforts among community-based organizations (CBOs) and other health care partners to create a more resilient, flexible, and accessible social care system that reduces health disparities and advances health equity. The SCN will collaborate with CBOs and other health care partners, leveraging shared data and technology to coordinate social care services for Medicaid members to improve access, ensure reliable and timely referrals, streamline and track navigation and completed referrals in closed loop systems and enhance collaboration between social care service providers and other regional partners.

Organizational Overview:

The Forward Leading Independent Provider Association (FLIPA) is a nonprofit membership association of safety net providers working in partnership to provide the highest quality healthcare to the most vulnerable populations in Upstate New York since 2017. FLIPA is renowned for its commitment to integrating primary care, behavioral health and social care. Our growing membership includes a combination of federally qualified health centers (FQHCs), behavioral health providers, and a rural health network across more than 27 counties.

FLIPA values diversity in background and experience. All qualified applicants are encouraged to apply and will receive consideration for employment without regard for race, color, religion, age, sex, gender identity or expression, national origin, disability status, veteran status or any other characteristic protected by federal, state, or local laws.

Job Summary:

The SCN Claims & Billing Manager is responsible for the planning, organizing, and direct oversight of all claims and billing processing, revenue monitoring, and support of quality improvement initiatives to assure compliance and funds flow to CBOs for work performed. The incumbent will work collaboratively with SCN team members to ensure timely and efficient billing, reporting, and CBO payment management; auditing of procedures in order to manage quality, increase efficiencies, reduce fiduciary risk, and assure claims meet requirements for reimbursement; and ensure training and technical assistance supports performance improvement.

Duties/ Responsibilities:

Perform overall revenue management including: satisfying timely filing requirements, maximizing billing revenue and collections, and resolution of denied/rejected claims
Prepare, review, and submit properly coded claims via identified system
reports and analyzes data to ensure clean submissions, identify duplications, confirm valid coding, and provide follow-up and feedback where there are discrepancies/irregularities
Reviews A/R and payment aging reports to recognize and investigate trends and underpayments, ensure proper action on any unpaid claims, and takes steps to appropriately correct and re-bill for reimbursement
Promptly identifies, researches, and resolves system issues through direct contact with payors and software vendors
Provide technical expertise and assistance in claims submission and billing
Research and maintain billing compliance, including staying up to date with regulations and best practices for SCN screenings/services billing to Medicaid,
Assists in the development, implementation, and maintenance of revenue cycle standard operating procedures (SOPs)
Periodically audits current SCN billing and claims procedures to monitor and improve efficiencies of operations and ensures activities of the billing and claims operations are conducted in a manner that is consistent with the overall SCN operational goals
Provides monthly updates of revenue cycle status including reports, metrics, and presentations
Work with Director of Finance & Contracting and the Contracting Accountant as needed to accomplish tasks
Work closely with the closed-loop referral system vendor and SCN Systems Administrator to identify and work to resolve systemic issues
Participate in the development and delivery of claims and billing training as required to SCN and CBO Partner staff regarding billing and other revenue cycle related tasks, and standard operating procedures (SOPs)
In collaboration with FLIPA SCN leadership, develop priorities for continuous quality improvement to revenue cycle outcomes
Handle and be knowledgeable of all software utilized in the management of operations related revenue for SCN, including understanding of pertinent service contracts
Maintain professional and technical knowledge by attending educational workshops, and other activities such as reviewing professional publications; establishing personal networks; participating in professional societies
Maintain documents and records in accordance with all regulatory requirements
Other duties as assigned

Education & Experience:

Bachelor’s degree in a business or related field or relevant experience with progressive development of responsibilities
Minimum of five years claims management and billing experience
Experience working with Medicaid Managed Care Organizations and understanding of billing requirements for key partners (including Federally Qualified Health Centers, outpatient and residential OMH and OASAS licensed facilities, and others)
Experience and/or working knowledge of CBO’s, networks/collaboratives, and NYS health system in the Finger Lakes Region preferred

Skills, Knowledge, and Abilities:

Proficient in the use of medical billing software applications and general MS Office applications
Ability to prepare and present proposals, reports, updates, summaries, etc.
Highly organized with the ability to effectively set goals and prioritize tasks
Ability to build constructive working relationships with internal and external partners
Strong interpersonal skills, independently resourceful and thrives in a fully remote environment
Takes responsibility for the quality and timeliness of work and achieves results with little oversight

Salary Range:

Salary is commensurate to education and experience with range of $60-80k.

Additional Info:

This position will be remote with occasional travel expected for on-site meetings or training across Finger Lakes Region and New York State
New York state residency a plus but not a requirement

You may contact us using this form or email jobs@forwardleadingipa.org

Equal Employment Opportunity Statement:

At Forward Leading IPA (FLIPA), we deeply value diversity in background, experience, and thought. We are committed to creating an environment of belonging where all qualified applicants are encouraged to apply and will receive equal consideration for employment. We do not discriminate based on race, color, religion, age, sex, gender identity or expression, national origin, disability status, veteran status, or any other characteristic protected by federal, state, or local laws.

We believe that fostering spaces of belonging and advancing health equity begins with a workforce that reflects the diverse communities we serve. We actively promote equity of opportunity and strive to ensure that each team member’s unique skills, talents, and potential are recognized and valued. We are dedicated to supporting and welcoming a wide range of candidates, making hiring decisions based solely on individual merit.

FLIPA is committed to prioritizing the human element in healthcare. By embracing diverse perspectives and fostering innovative thinking, we aim to build empowered, healthy, and thriving communities. Join us on this journey and contribute to a mission that makes a meaningful impact.