SCN Billing Specialist

POSITION SUMMARY

Reporting to the Manager of Revenue Integrity & Compliance, the SCN Billing Specialist for Care Compass Collaborative is responsible for managing the billing and reimbursement processes for services delivered under the New York Health Equity Reform (NYHER) 1115 Waiver. This includes ensuring accurate and timely submission of claims for Health-Related Social Needs (HRSN) services such as housing, nutrition, transportation, and care management. The Billing Specialist will work closely with the Revenue Cycle Team to ensure compliance with state and federal billing guidelines. 

RESPONSIBILITIES:

The responsibilities of the SCN Billing Specialist will include the following:

Essential Functions:

• Prepare and submit claims for HRSN services in accordance with NYSDOH billing protocols and SCN Operations Manual  
• Verify member eligibility and service authorization using Medicaid data systems and SCN IT platforms 
• Track and reconcile payments, denials, and resubmissions; follow up on unpaid or underpaid claims
• Maintain accurate billing records and documentation for audit readiness 
• Collaborate with Social Care Navigators, care managers, and provider agencies to resolve billing discrepancies 
• Stay current on NYHER 1115 Waiver updates, billing codes, and reimbursement policies  
• Participate in training sessions and stakeholder meetings to align billing practices with evolving SCN requirements   

 Non-Essential Functions: 

 May assume additional responsibilities, as requested. 

MINIMUM REQUIREMENTS:

• High School Diploma and 2 years’ experience required or Associate’s degree in Health Administration, Accounting, or related field, preferred 
• Minimum 2 years of experience in Medicaid billing, preferably in a community-based or managed care setting 
• Proficiency in billing software, Medicaid portals, and electronic health record (EHR) systems 
• Strong attention to detail, organizational skills, and ability to manage multiple priorities 
• Excellent communication and critical thinking skills 
• Working knowledge of Microsoft Office 365 

 LICENSE/CERTIFICATION:  

• Minimum Required: N/A 

 PREFERRED SKILLS: 

• Knowledge of NYS Medicaid Managed Care billing requirements 
• Familiarity with 1115 Waiver programs, HRSN services, and SCN workflows is highly desirable 
• Experience with Unite Us or similar referral platforms used in SCN operations, such as MillinPro
• Understanding of social determinants of health and community-based service delivery 
• Knowledge of NYS OMH, OASAS, and OPWDD or other rate-based billing is a plus 

 WORK ENVIRONMENT: 

• Care Compass Network utilizes a hybrid work model where employees are able to work remotely from a home office or from the CCN office, a non-clinical professional office setting. There may be some travel required for partner and/or network meetings.