Location: St. Joseph Medical Center
Posted Date: 9/26/2024
Job Type: Full Time
Department: 4119.71800 Communications
Under the direction of the Director of Revenue Cycle or designee, the Medicaid Billing Specialist ensures all traditional Medicaid and Medicaid Managed Care claims are reviewed for claim edits, claim submission, and timely follow up, as assigned.
Duties and Responsibilities:
- Review claims before submission for missing modifiers, charges, and/or implants
- Validate and make corrections on the UB04 resolving all claim edits before claim submission
- Validate pharmacy quantities are reflected on the claim correctly
- Validate claim against the coding abstract to ensure accurate billing of procedures
- Review 24 and 72-hour admission report combining claims, as needed
- Split inpatient claims as appropriate, per carrier guidelines
- Submit claims to carriers with the appropriate remarks and/or attachments
- Run insurance eligibility and correct claim before submission as needed
- Pull supporting documents for annual regulatory audits, as needed
- Ensure Medicaid credit balances are reviewed and resolved timely
- Other billing assignments, within skillsets and abilities
Education:
- High School graduate or equivalent
Experience:
- Minimum 2-years Medicaid billing experience in an acute care facility
- Working knowledge of Common Procedural Terminology (CPT) and ICD10 Codes
- Working knowledge of Federal, State, and Commercial billing guidelines
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