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Key skills for this role
Monitor and reconcile provider entries and run remittance reports to ensure proper billing and payment for assigned provider accounts
Perform regular audits to confirm appropriate billed services and ensure accurate and timely payments
Ensure compliance with Elwyn ELS billing practices, policies, and procedures by leveraging strong knowledge of the contractual requirements for providers
Conduct timely analysis of agency provider/contractor data entry, daily monitoring of units of service in the database, spot checks, and data integrity audits
Run electronic verification system (EVS) checks for MA billing eligibility through the state system
Coach, guide, and train contractors in the use of the Managed Service Portal (MSP) to enter units of service provided to ensure appropriate payment
Provide consultation and training to providers in all billing-related matters to ensure consistency throughout the program and provide on-the-spot technical assistance
Act as the primary liaison maintaining frequent communication between Elwyn Early Learning Services and providers regarding all billing-related reconciliation issues
Communicate effectively with staff, providers, agencies, management, and office personnel from local, state, federal government, and/or its third-party contractors to reconcile any billing-related issues
Generate Medical Practitioner Authorizations (MPAs) for MA-eligible children and send them to physicians for signature authorization of services
Compile and distribute monthly remittance files by extracting necessary data from the system database to external providers, ensuring accuracy of the service data and the rates applied
Analyze data inconsistencies caused by provider data entry errors and remediate the cause of the errors
Address critical problems and communicate unresolved issues to the Lead Billing and Credentialing Specialist and/or Provider Agency for timely resolution
Perform other duties as assigned
Skip the repetitive application forms
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High School Diploma or General Education Diploma (GED)
Two (2) years of experience in third-party billing and collection procedures
One (1) year of experience with Medical Assistance (MA) billing
Experience with the School-Based Access Program preferred
Experience with contract review preferred
Non-profit human service experience highly preferred
Working knowledge of computer-based billing platforms; Sprout and Pennsylvania's Enterprise to Link Information for Children Across Networks (PELICAN) preferred
Demonstrated ability to work effectively as part of a team
Ability to work in a fast-paced environment and manage and prioritize multiple, often competing, priorities to meet deadlines
Strong attention to detail
Strong time management and organizational skills
Excellent judgment with the ability to independently solve problems and make decisions with little need for direct supervision
Ability to anticipate future needed changes or identify problem areas and take effective actions
Intermediate knowledge of Microsoft Office applications, including Word, Outlook, Excel, and PowerPoint
Must possess excellent customer interaction, collaboration, presentation, and written and verbal communication
Elwyn is an Equal Opportunity Employer. Elwyn does not discriminate on the basis of race, color, religion, creed, ancestry, pregnancy status, medical condition, gender, gender identity or expression, genetic information, sexual orientation or identity, age, national origin, citizenship, handicap status, marital or family status, mental or physical disability, perceived disability, military or veteran status, political activities or affiliations, or any other characteristic protected under applicable federal, state or local law, ordinance, or regulation.
If you need a reasonable accommodation for any part of the employment process, please contact us by email at ADArequest@elwyn.org and let us know the nature of your request and your contact information.
Know Your Rights: Workplace discrimination is illegal
Non-profit provider of disability support and behavioral health services.
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Entry · 2+ years experience
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