Summary Description: Bureau of Revenue focus on optimization of insurance billing and reimbursements for service provided to insured New Yorkers that seeks services in the article 28 Health specialty Clinics, Article 36, and other Care Management service areas provide by DOHMH to meet NYS Article 6 requirements. DOHMH remains committed to providing services for NYC uninsured and under insured residents. Reporting to the Assistant Director of Patient Billing by working alongside a team of talented health insurance billing specialist, you will perform health insurance billing activities and support functions including claim review, claim submission, follow up and collection activities. Applicants must be detailed oriented and must have a minimum of 5 years of work experience, basic knowledge CPT/ICD 10 codes and comprehensive understanding of the 10 steps in the revenue cycle

Job Duties and Responsibilities:
- Work closely with the assistant director to oversee billing and collection activities within the unit.
- Run and review daily billing reports for the unit, identify issues and provide feedback to the Assistant Director.
- Track and communicate updated patient demographics and insurance information with clinic teams to ensure transparency.
- Track and manage medical records requests from MCO to obtain prior authorization approvals and claim reimbursement.
- Review all claims CPT/ICD-10/HCPCS, payment modifiers in billing software to ensure accuracy following CMS and other third-party insurance guidelines.-
- Monitor EDI denials in a timely manner.
- Prepare and batch claims out to third party payers for reimbursements.
- Review clearinghouse acceptance and rejection reports.
- Edit and make correction to rejected claims and re-batch to third party payers.
- Monitor aging accounts receivable reports (A/R) and provide feedback to Assistant Director of Patient Billin
- Report industry billing trend and changes to Assistant Director of Patient Billing.

INSURANCE ADVISOR (HEALTH) - 40236

1. A master's degree from an accredited college with a specialization in business or public administration, financial management, or public health, and two years of full-time satisfactory experience in employee benefits or health insurance as a manager, research analyst, or underwriter, or in public health education. One year of such experience must have been in group benefits or group health insurance; or
2. A baccalaureate degree from an accredited college and three years of full-time satisfactory experience as described above; or
3. Education and/or experience equivalent to "1" or "2" above. Certification as a Certified Employee Benefits Specialist from the International Foundation of Employee Benefit Programs can be substituted for one year of experience. However, all candidates must have at least a baccalaureate degree and one year of experience in group benefits or group health insurance as described in "1" above.

-Knowledge of medical terminology, eligibility and third=party reimbursement -Strong writing, speaking and active listening skills. -Working knowledge of obtaining prior approvals via managed care payer portals. -Excellent problem solving and critical thinking skills. -knowledge of Health Insurance industry best practices. -Basic knowledge of Article 28/36 New York State billing requirements -Working knowledge of Microsoft applications including, Teams, Excel spread sheets, PowerPoint and basic knowledge of accounting principles. -Ability to work independently, collaborate with others, multitasking, and a team player. Why you should work for us: - Loan Forgiveness: As a prospective employee of the City of New York, you may be eligible for federal/state loan forgiveness and repayment assistance programs that lessen your payments or even fully forgive your full balance. For more information, please visit the U.S. Department of Education’s website (https://studentaid.gov/pslf/) - Benefits: City employees are entitled to unmatched benefits such as: o a premium-free health insurance plan that saves employees over $10K annually, per a 2024 assessment. o additional health, fitness, and financial benefits may be available based on the position’s associated union/benefit fund. o a public sector defined benefit pension plan with steady monthly payments in retirement. o a tax-deferred savings program and o a robust Worksite Wellness Program that offers resources and opportunities to keep you healthy while serving New Yorkers. - Work From Home Policy: Depending on your position, you may be able to work up to two days during the week from home. - Job Security - you could enjoy more job security compared to private sector employment and be able to contribute to making NYC a healthy place to live and work. Established in 1805, the New York City Department of Health and Mental Hygiene (NYC Health Department) is the oldest and largest health department in the U.S., dedicated to protecting and improving the health of NYC. Our mission is to safeguard the health of every resident and cultivate a city where everyone, regardless of age, background, or location, can achieve their optimal health. We provide a wide array of programs and services focused on food and nutrition, anti-tobacco support, chronic disease prevention, HIV/AIDS treatment, family and child health, environmental health, mental health, and social justice initiatives. As the primary population health strategist and policy authority for NYC, with a rich history of public health initiatives and scientific advancements, from addressing the 1822 yellow fever outbreak to the COVID-19 pandemic, we serve as a global leader in public health innovation and expertise. Come join us and help to continue our efforts in making a difference in the lives of all New Yorkers! The NYC Health Department is an inclusive equal opportunity employer committed to providing access and reasonable accommodation to all individuals. To request reasonable accommodation to participate in the job application or interview process, contact Sye-Eun Ahn, Director of the Office of Equal Employment Opportunity, at sahn1@health.nyc.gov or 347-396-6549.

This position is also open to qualified persons with a disability who are eligible for the 55-a Program. Please indicate at the top of your resume and cover letter that you would like to be considered for the position through the 55-a Program.

As a prospective employee of the City of New York, you may be eligible for federal loan forgiveness programs and state repayment assistance programs. For more information, please visit the U.S. Department of Education’s website at https://studentaid.gov/pslf/.

New York City residency is generally required within 90 days of appointment. However, City Employees in certain titles who have worked for the City for 2 continuous years may also be eligible to reside in Nassau, Suffolk, Putnam, Westchester, Rockland, or Orange County. To determine if the residency requirement applies to you, please discuss with the agency representative at the time of interview.

The City of New York is an inclusive equal opportunity employer committed to recruiting and retaining a diverse workforce and providing a work environment that is free from discrimination and harassment based upon any legally protected status or protected characteristic, including but not limited to an individual's sex, race, color, ethnicity, national origin, age, religion, disability, sexual orientation, veteran status, gender identity, or pregnancy.