EI Program Billing Reimbursement Specialist

State of North Carolina

About The Position

The North Carolina Department of Health and Human Services (DHHS) is one of the largest, most complex agencies in the state, and has approximately 17,000 employees. It is responsible for ensuring the health, safety, and well-being of all North Carolinians, providing human service needs for special populations including individuals who are deaf, blind, developmentally disabled, and mentally ill, and helping poor North Carolinians achieve economic independence. Description of Work Project Management -- leads and/or participates in work groups or projects. Obtains authorization and commitment and demonstrates business need and project feasibility. Works with staff from both CDSAs and other organizations, as needed in planning and coordinating projects and meetings. Attends meetings as assigned, completes assignments and prepares/submits meeting summary. Data Review/oversight -- analyzes operations and reviews reports, recommendations, and justifications to ensure that planned activities support both EI Branch and CDSA staff in the achievement of compliance and performance goals and expectations. Reviews and evaluates information on service delivery system methods, billing systems, outputs, and activities to identify gaps in resources and recommend improvements. Works with program staff in determining trends and resolving technical problems. Assists with developing rules, policy and procedures in Medicaid, private insurance, financial and administrative areas. Technical Assistance -- leads and participates in program planning, development, and implementation, specifically in regard to technical assistance and training needs of both the EI Section and CDSA staff in administrative, financial and funding sources, including Medicaid Direct, Managed Care Organizations, and private insurance. Serves as a liasion between the EI Section and Medicaid. Creates and implements steps for the planning, development and implementation of technical assistance for the statewide IDEA, Part C program and specific Medicaid funding and billing requirements. Participates in the development and delivery of technical assistance in writing, in person, and through webinars. Works with EI Section staff and others to develop and implement effective techniques for evaluating technical assistance and training to CDSAs. Other duties as assigned.

Requirements

Demonstrated experience interpreting and applying Medicaid, Managed Care Organization (MCO), and private insurance reimbursement policies, evidenced by providing billing or reimbursement guidance, resolving coverage or claims issues, interpreting third-party payor standards, and supporting billing compliance activities within public health, human services, or healthcare programs.
Demonstrated experience providing formal technical assistance, consultation, and training related to billing practices, reimbursement systems, and financial reporting, evidenced by developing written guidance, conducting trainings or webinars, consulting with providers or agencies, and serving as a liaison with Medicaid, MCOs, or managed care entities.
Demonstrated experience interpreting and applying administrative, fiscal, and compliance policies and procedures, evidenced by authoring or maintaining procedures, responding to formal policy inquiries, participating in fiscal or compliance monitoring, and supporting the development or revision of billing, reimbursement, or financial policies.
Demonstrated experience participating in program planning, evaluation, quality assurance, or compliance monitoring activities, evidenced by involvement in audits, monitoring reviews, corrective action planning, performance tracking, or quality improvement initiatives.
Demonstrated experience analyzing programmatic and fiscal data to support billing oversight, compliance, and decision-making, evidenced by reviewing utilization, reimbursement, or expenditure data; identifying trends, gaps, or variances; preparing leadership or ad-hoc reports; and applying data findings to improve reimbursement processes.
Bachelor’s degree from an appropriately accredited institution and three (3) years progressively responsible experience related to the area of assignment; or an equivalent combination of training and experience.

Nice To Haves

Experience with Part C El program
Experience with Medicaid and private insurance coding using ICD-10 and reimbursement practices
Experience collecting and analyzing fiscal data
Knowledge of IDEA, privacy, confidentiality laws and regulations on both federal and state levels.

Responsibilities

Leads and/or participates in work groups or projects
Obtains authorization and commitment and demonstrates business need and project feasibility
Works with staff from both CDSAs and other organizations, as needed in planning and coordinating projects and meetings
Attends meetings as assigned, completes assignments and prepares/submits meeting summary
Analyzes operations and reviews reports, recommendations, and justifications to ensure that planned activities support both EI Branch and CDSA staff in the achievement of compliance and performance goals and expectations
Reviews and evaluates information on service delivery system methods, billing systems, outputs, and activities to identify gaps in resources and recommend improvements
Works with program staff in determining trends and resolving technical problems
Assists with developing rules, policy and procedures in Medicaid, private insurance, financial and administrative areas
Leads and participates in program planning, development, and implementation, specifically in regard to technical assistance and training needs of both the EI Section and CDSA staff in administrative, financial and funding sources, including Medicaid Direct, Managed Care Organizations, and private insurance
Serves as a liasion between the EI Section and Medicaid
Creates and implements steps for the planning, development and implementation of technical assistance for the statewide IDEA, Part C program and specific Medicaid funding and billing requirements
Participates in the development and delivery of technical assistance in writing, in person, and through webinars
Works with EI Section staff and others to develop and implement effective techniques for evaluating technical assistance and training to CDSAs
Other duties as assigned.