Medicaid Specialist
Medicaid Specialist
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Overview
Analyzes investigates and resolves claims/billing information and/or errors associated with inpatient and outpatient Medicaid claims. Ensures compliance with Medicaid guidelines and MMC organizational policies.
Qualifications
Education:
- Education equivalent to graduation from high school or GED is required.
Experience:
Two or more years of insurance and/or health care billing experience is required. Previous experience with Medicaid billing and software (IDPA payment system SMS and NEBO) is highly preferred
Other Knowledge/Skills/Abilities:
- Basic working knowledge of personal computers and their associate user software is required. Experience with Microsoft Office products Word and Excel is preferred.
- Ability to multitask while working on multiple responsibilities simultaneously.
- Demonstrated ability to work successfully with internal customers and external contacts is required.
- Possesses a highlydeveloped critical thinking and problem solvingability to work through complex situations.
- Demonstrates excellent oral and written communication keyboarding basic math and problem solving skills.
Familiarity with medical terminology medical procedural (CPT) and diagnosis (ICD9 CM) coding and hospital billing claim form UB04 is highly preferred.
Responsibilities
Utilizes electronic software to determine Medicaid insurance eligibility and coverage for inpatient and/or outpatient Medicaid claims.
Receives and examines daily listings for assigned billing claims and determines which require further analysis and action.
Investigates assigned billing claims with incomplete/incorrect information and resolves problems or errors to ensure complete and Medicaidcompliant information accompanies the claim.
Prioritizes claims based on specified criteria and electronically files the claim ensuring careful adherence to Medicaid guidelines timeliness accuracy and processing procedures. At prescribed intervals follows up for review to ensure smooth processing and timely delivery of monetary reimbursements.
Follows up and investigates unpaid items and other issues associated with unpaid claims. Contacts patients guarantors or other sources of third party payment and secures arrangements for prompt payment.
Receives and researches Medicaid claim denials and as necessary prepares the necessary paperwork to appeal the denial.
Reviews correspondence relating to Medicaid payments and claims; conducts the necessary research to provide supplementary background information regarding the inquiry.
Researches and resolves complex issues associated with Medicaid accounts. As applicable identifies documents and reports problematic trends to management.
Analyzes reports containing rejected account information and performs the necessary research to resolve the reason(s) for the rejection and secures any other required information.
Provides input regarding system edits designed to identify and ensure consistent and compliant data necessary for processing Medicaid claims.
Responds to requests from internal departments regarding the proper coding billing and processing of Medicaid claims.
Communicates and resolves issues with a variety of internal and external sources to resolves issues involving Medicaid claims. This may include internal departments patients (or other responsible parties) thirdparty payors social service agencies Medicare/Medicaid staff other insurance carriers service providers and collection agencies.
Initiates corrections to charges and contractuals / allowances within scope of expertise and authority granted.
Identifies and calculates writeoff amounts and secures the necessary approvals from management for processing.
Documents online systems and electronic files to ensure accurate data is noted regarding the status of claims and payments.
Ensures compliance to Medicaid policy guidelines and processes at each work step to facilitate accurate and timely reimbursements to the organization.
As directed and defined by management orients and crosstrains on other unit duties which are outside of regularly assigned area of responsibility. May serve as a backup for other areas within the unit or department especially during times of special needs or staff absences.
Performs other related work as required or requested.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
