Medical Billing Specialist - Medicaid Managed Care

Medical Billing Specialist - Medicaid Managed Care

Health Partners of Western Ohio is an independent, non-profit and community-directed organization. We serve low-income areas and places without access to care. We're led by a volunteer Board of Directors. Most of our board members are also patients. Our Mission is to eliminate gaps in health outcomes for all members of our community by providing access to quality, affordable, preventive and primary health care.

Position Purpose

With knowledge of FQHC billing requirements, the Accounts Receivable Specialist prepares, submits, and follows up on insurance claims to the state Medicaid program to support an efficient and effective revenue cycle.

Essential Functions and Basic Duties

• Reviews all claims before submission to insurance companies.
• Maintains file system for billed claim records and back up for audit purposes.
• Verifies coverage and follows up on submitted claims.
• Requests corrected diagnosis for reimbursement purposes from providers.
• Responds knowledgeably to inquiries from patients, providers, insurance companies regarding covered charges, remittance advices, and billing questions.
• Works with Medicaid, Medicare, and insurance companies for submission of claims, to verify coverage, to determine status of claims, and to resolve issues and problems with the claims.
• Reviews incoming correspondence and materials.
• Maintains a variety of files, logs, and registers.
• Operates office equipment
• Reviews insurance information in computer registration to determine accuracy and make changes as needed.
• Opens mail and processes all patient payments, insurance reimbursements, and reconciles daily report with checks received.
• Maintains updated knowledge of FQHC billing rules, CPT, CDT, and ICD-10 coding.
• Maintains patient confidentiality according to health center policy and HIPAA regulations.
• Performs miscellaneous job-related duties as assigned.

Qualifications

• High School Degree or GED Required.
• Successful completion of in-house training.
• Experience with healthcare billing preferred.

• Understanding of different types of insurance (Medicaid, Medicare, Commercial, etc.)
• Computer experience, skill and typing ability sufficient to operate the practice management.
• Knowledge of basic medical terminology.

What We Offer

• Starting pay $21.60 and goes up based on experience in Federally Qualified Health Center billing
• Paid Time Off (PTO) Accrued per pay
• Insurance (Medical, Dental, Vision, Life and Disability)
• Paid Holidays 7 paid holidays
• 403b Retirement with up to 8% match (starts at 3% and increases with time of service at HPWO)
• Annual Reviews and Increases
• Employee Assistance Program
• Referral Bonus Earn more by expanding our team
• Training Opportunities
• Eligible to apply for the Emerging Leaders Program after 1 year of service