Overview
Position Summary:
The Billing Specialist, Medicaid ensures proper submission and adjudication of all claims submitted to Medicaid carriers while working within the deadlines and protocols of the assignments. This position will focus primarily on reviewing and assessing Medicaid denials or returned claims. Must be able to communicate with all states Medicaid and MCO’s from a resolution-based perspective. This communication should be focused on acquired knowledge, insurance carrier guidelines, company policies & procedures, research, and collection efforts.
Duties & Responsibilities
- Responsible for understanding all procedures within regulatory mandates.
- Initiating claims adjustments and resubmission of claims to Medicaid and MCO’s.
- Evaluates payments/denials received for correctness and ensures they are applied accordingly.
- Maintains contact with other departments to obtain patient or insurance information needed for claim payment.
- File and handle confidential documentation and patient health information (PHI); adhere and follow all HIPAA mandated guidelines.
- Maintains a broad range of knowledge of insurance plans, medical terminology, billing procedures, government regulations, and medical codes.
- Analyze and evaluate Medicaid claim payments using the company's systems and tools. Use payment documentation provided by payers to determine if the medical provider has been reimbursed in compliance with the applicable state fee schedule.
- Ensures that the activities of the collection operations are conducted in a manner that is consistent with overall department protocol, and are following Federal, State, and payer regulation, guidelines, and requirements.
- Conduct timely and thorough telephone follow-up with Medicaid to ensure claims with supporting documentation have been received and facilitate prompt reimbursement.
- Assist in efficiently moving work through the department, working as part of a team. Identifying and investigating Medicaid claims issues to resolution/payment.
- Follows up on claims submitted to ensure carrier has received into adjudication for the receipt of prompt and timely payment. Escalates issues, as necessary.
- Identifies bad debt write-offs and A/R adjustments. Initiates write-offs and adjustments in accordance with policies and procedures.
- Strong interpersonal and communication skills with an ability to work effectively with teams, managers, and executive staff.
- Verifies billing accounts with accounts receivable ledger to ensure that all payments are accounted for and properly posted.
- Documents, in detail, phone calls, phone number, person spoken to, and call details on a consistent basis.
- Identifies any overpayments and/or duplicate payments and investigates and resolves accordingly.
- Send secondary claims as soon as primary remit is received to avoid delays with payment.
- Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
- Resolves issues that created a denial within 3 days of receipt of denial.
- Familiar with Electronic Medical Records and Billing Systems.
- Timely medical records request for Appeal Process.
- Reducing outstanding A/R and aging reports.
- Perform any other duties.
Requirements:
- Associates degree preferred, will take five years’ experience in lieu of degree.
- 3-5 years of healthcare industry experience required.
- 3-5 years of medical billing and collections experience required.
- 3-5 years of knowledge in a behavioral health or medical clinic setting preferred, but not necessary.
- Exhibit high quality work.
- Use excellent judgment.
- Communicate clearly.
- Take the initiative to identify and resolve issues.
- Willing to learn and take on new tasks.
- Demonstrate resourcefulness and cooperation.
- Exhibit BI’s core values in all interactions.
Upholding Integrity, Excellence, and the Heart of ABA:
For over 22 years, Behavioral Innovations has been providing center-based, evidence-based ABA Therapy across Texas, Oklahoma, and Colorado. Our Culture of excellence, teamwork, and care is guided by our core values and mission. Join us in making a positive impact on the lives of children diagnosed with autism and other developmental disorders. At Behavioral Innovations (BI), our values drive us every day. Recognized with the Clinical Excellence Award in 2021, crowned Company of the Year in 2022, and listed on the prestigious Inc. 5000, we are proud to be one of America's Fastest Growing Private Companies.
#J-18808-Ljbffr
