Medicaid Billing Specialist
2 weeks ago
Regency Integrated Health Services is seeking a highly skilled Medicaid Billing Specialist to join our team. As a Medicaid Billing Specialist, you will be responsible for billing required claims in a timely and accurate manner, ensuring that payments are received and meeting monthly goals.
Key Responsibilities- Medicaid Billing: Bill required claims within established timeframes, ensuring accurate and timely submission.
- Claims Reconciliation: Reconcile cash monthly for MCO and Medicaid payers, verifying all payments have been posted for the month.
- Appeals and Reconsiderations: Process appeals and reconsiderations for each resident in MCO or MCD payers for facilities assigned.
- Medicare Coinsurance Billing: Bill Medicaid Coinsurance as required by BOM notification or aging review once Medicare claim has paid date.
- Reporting and Communication: Report issues with specific payers to the CBO AR Manager, ensuring timely and effective communication with field staff and facility staff.
- Billing Notes and Records: Maintain accurate and up-to-date billing notes in PCC for all accounts worked in MCO and Medicaid payers.
- Bad Debt Completion: Complete bad debt on Past Filing Deadline receivables if required due to failure to reclass and bill timely or failure to submit clean claim within billing time frames.
- Medicaid Resident Review: Review all Medicaid residents MESAV to show service authorization, eligibility, level of service, applied income, and MCO payer type if applicable in order to bill claims.
- Service Authorization and Eligibility: Assist Business Office Managers by submitting service authorization (3618/3619 forms) as needed and communicate with Medicaid Case Workers by Case Status Reports on missing or invalid information regarding residents Medicaid eligibility.
- Payer Tree Setup and Maintenance: Accurately set up Medicaid payer trees along with applied income and level of service (RUG) in PCC on each Medicaid resident.
- Durable Medical Equipment Billing: Bill approved durable medical equipment to TMHP and submit refunds to the DME provider once payment is received, including PASRR approved therapy charges.
- Collection Goals and Reporting: Maintain company collection goals and provide reasons for not meeting collections.
- Monthly Aging Reviews: Participate in monthly aging reviews with Business Office Manager, Regional Accounts Receivable Manager, Administrator, Regional Vice President of Operations, Vice President of Accounts Receivable, Chief Financial Officer, and Chief Executive Officer.
- Time and Attendance: Maintain proper time and attendance along with possessing a positive attitude and productive work environment.
- Experience: 2 years minimum Medicaid Skilled Nursing Billing Experience is required.
- Skills: Ability to work well with others as a team and have strong customer service and communication skills is required.
- Education: High School diploma required; Associates Degree preferred.
- Software Experience: Point Click Care Software experience is preferred; Simple LTC software experience is preferred.
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