Medicaid Billing Specialist
Medicaid Billing Specialist
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Job Description
BASIC FUNCTION: Possess and apply thorough knowledge to all aspects of program billing processes including eligibility coding and insurance/payer requirements. Also responsible for accurate and timely grant and other billings and reports as assigned.
MINIMUM QUALIFICATIONS:
- Experience and knowledgeable on governmental payers Medicare and Medicaid dealing with Substance Use Disorders.
- Knowledgeable on the credentialing and recredentialing processes
- Knowledgeable on insurance billing collections and reimbursement processes
- High school diploma or GED required
- Basic accounting skills knowledge of Excel and other Microsoft Office products.
- Must be available to work Monday-Friday standard business hours
PRINCIPAL ACCOUNTABILITIES:
- Ensures claim information is complete and accurate by reviewing claims for discrepancies
- Identify potential issues as it relates to coding or insurance requirements and when needed works with the proper staff member to correct errors
- Monitor claim submission statistics via generated reports
- Follows up with insurance companies on unpaid or rejected claims to determine and resolve any outstanding issues and re-submit corrected claims if necessary
- Investigate verify and analyze patients eligibility results for any medical coverage and obtain proper billing contact information
- Request or obtain documentation where applicable
- Enters information necessary for insurance claims such as client insurance provider as well as diagnosis recommended by LCDC Licensed Chemical Dependency Counselor treatment codes and modifiers if applicable.
- Submits insurance claims to clearinghouse or individual insurance companies electronically or via paper
- For clients with coverage by more than one insurer prepares and submits secondary claims upon processing by primary payer
- Follows HIPAA guidelines in handling patient information
- Contact providers for credentialing and credentialing applications gather and submit required documentation for credentialing.
- Verify with the insurance company that the credentialing application was received and follow up with the insurance network on a regular basis until your credentialing is complete and you have a network effective date with a participating provider agreement
- Respond to any requests for additional information that the insurance company may have
- Document all of your follow up activities as you go through the credentialing process
- Review your participating provider contract for details of your requirements as a network provider claims submission procedures fee schedule for your services timely filing limits and all other important contract terms
- Keep copies of all credentialing applications and contracts submitted. Retain a final copy of any network contracts
- Generate reports for Director
- Performs other duties as assigned.
Other Skills/Experiences:
- Strong organizational skills and attention to detail
- Excellent written and verbal communication skills
- Ability to work independently with minimal direction and oversight as well as with a team
- Ability to handle multiple responsibilities under strict deadlines and prioritize efficiently
- Familiarity with HIPAA privacy guidelines and maintains and protects all confidential information
PHYSICAL AND MENTAL REQUIREMENTS: Prolonged periods of using a computer and sitting at a desk. Ability to review and analyze data and effectively communicate with internal and external customers.
WORK ENVIRONMENT: Office
OCCUPATIONAL EXPOSURE CATEGORY: None
WORK SCHEDULE: This position is non-exempt and is eligible for overtime. Typical hours are Mon -Friday 8-5. On occasion may be asked to participate in special events that may occur on the weekend or in the evenings.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
