Job Description

Company Summary:

ChildNet, Inc. is a private, not-for-profit community-based care (CBC) agency servicing Broward and Palm Beach County. We are contracted with the State of Florida, Department of Children and Families, to provide case management support to abused, abandoned, and neglected children. ChildNet is nationally accredited by the Council on Accreditation (COA) and employs over 450 staff at its location in Ft Lauderdale and West Palm Beach, Florida. 

Job Summary: This position interprets and processes medical bills and completes payments for accounts payable from physicians, dentists, specialists, hospitals, medical supply companies and licensed care providers in Broward and Palm Beach.

Responsibilities:

  •  Processes bills received from providers, case management, and licensed care providers.
  •  Interprets and reprices itemized bills received; individual procedure codes are repriced to reflect the Florida Medicaid reimbursable rate according to the Medicaid fee schedule.
  •  Negotiates child’s health fees with providers when applicable with and without Medicaid.
  • Prepares check requests for payment to providers and obtains and ensures all signatures are received before submitting to finance.
  • Verifies child’s medical and dental insurance through various systems.
  • Maintains up to date knowledge of the Florida Medicaid fee schedule for all professional specialties.
  • Works with insurance companies to resolve pending invoices and claims.
  •  Works with pharmacies to ensure prescriptions are covered by Medicaid.
  • Facilitates the resolution of all issues concerning invoices sent from collection agencies.
  • Creates and maintains a spreadsheet for tracking provider payments.
  •  Functions closely with other team members of the Medical Unit to discuss, evaluate, and research medical services for children.
  • Obtains emergency Medicaid itemized statements from hospitals / ER physicians with the diagnosis code and completes the “2039” Medicaid Assistance form.” Determines if service was an emergency and sends form to Rev Max in order to apply for Florida Emergency Medicaid and have it opened within the 90-day deadline.
  • Tracks illegal / undocumented children on a spreadsheet and consults with case management regarding the movement toward obtaining legal status for Medicaid purposes. Efforts to obtain Medicaid are documented.
  • Performs payables and reconciliation functions according to established billing, payment and reporting cycles of agreed upon payment processes.
  • Maintains a complete file for each provider.

·         Other duties:

  • Serving as a liaison between client services, CBCIH and Sunshine Health.
  • Advising Child Advocates/Dependency Case Managers on case management issues regarding medical and dental insurance coverage.
  • Entering medical and dental documentation into FSFN.
  • Sort and research incoming mail.
  • Respect clients by recognizing their rights; maintaining confidentiality.
  • Maintain quality service by establishing and enforcing the agency’s standards.
  •  Recognizing, respecting and responding to the unique, culturally-defined needs of others served.

 

The items listed above are intended to provide an overview of the essential functions of the job. This is not an exhaustive list of all functions and responsibilities that the position may be required to provide.

Skills / Requirements

* Requires a high school diploma and/or higher education.

* Two (2) years experience working in a social welfare or healthcare environment preferred.

* Possess intermediate or better computer skills.

*Certification in Billing and ICD-10 Coding preferred.

* Able and willing to work with diverse client population.

* Must have valid Florida Driver's License

Important Notes

ChildNet is committed to equal employment opportunity for all applicants without regard to race, sex, age, religion, color, disability, national origin or ancestry, citizenship status, genetic information, marital status, veterans status or military service obligation, medical condition, sexual orientation, or gender identity or expression and any other status protected by applicable law.  Including Title VII of the Civil Rights Act, Section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act, and CFOP 60-10, Chapter 4. ChildNet is also a Drug-Free Workplace (DFWP).