Medicaid Billing Specialist Job at Behavioral Innovations
Overview:
Duties & Responsibilities
Essential Functions
Requirements:
Work Environment: Physical Demands
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
Essential Functions
- 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.
- Conduct timely and thorough telephone follow-up with Medicaid to ensure claims with supporting documentation have been received and facilitate prompt reimbursement.
- File and handle confidential documentation and patient health information (PHI); adhere and follow all HIPAA mandated guidelines.
- Assist in efficiently moving work through the department, working as part of a team. Identifying and investigating Medicaid claims issues to resolution/payment.
- Initiating claims adjustments and resubmission of claims to Medicaid and MCO’s.
- Follows up on claims submitted to ensure carrier has received into adjudication for the receipt of prompt and timely payment. Escalates issues, as necessary.
- Evaluates payments/denials received for correctness and ensures they are applied accordingly.
- Identifies bad debt write-offs and A/R adjustments. Initiates write-offs and adjustments in accordance with policies and procedures.
- Identifies any overpayments and/or duplicate payments and investigates and resolves accordingly.
- Maintains contact with other departments to obtain patient or insurance information needed for claim payment.
- Responsible for understanding all procedures within regulatory mandates.
- 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.
- 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.
- Resolves issues that created a denial within 3 days of receipt of denial.
- Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
- Maintains a broad range of knowledge of insurance plans, medical terminology, billing procedures, government regulations, and medical codes.
- Timely medical records request for Appeal Process.
- Send secondary claims as soon as primary remit is received to avoid delays with payment.
- Reducing outstanding A/R and aging reports
- Familiar with Electronic Medical Records and Billing Systems.
- Strong interpersonal and communication skills with an ability to work effectively with teams, managers, and executive staff.
- Perform any other duties
Professional:
- Demonstrating and promoting cultural values: Caring, Accountable, Collaborative, and Family-Focused. Adherence to policies and procedures (Code of Conduct, HIPAA, documentation standards, etc.).
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
Work Environment: Physical Demands
This position will work in the Corporate (Home) Office location. This is a high growth, fast paced organization and the work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Mental acuity to collect and interpret data, evaluate, reason, define problems, establish facts, draw valid conclusions, make valid judgement and decisions.
- Must be able to receive detailed information through oral and written communication.
- Must be able to communicate, convey and exchange information through oral and written communication.
- See near and far distances and distinguish colors.
- Noise level low to moderate.
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