Medicaid Billing Specialist

Job Title

Basic Function: Possess and apply thorough knowledge to all aspects of program billing processes including eligibility, coding, and insurance/payer requirements. Also responsible for accurate and timely grant and other billings and reports as assigned.

Minimum Qualifications

• Experience and knowledgeable on governmental payers Medicare and Medicaid dealing with Substance Use Disorders.
• Knowledgeable on the credentialing and recredentialing processes
• Knowledgeable on insurance billing, collections, and reimbursement processes
• High school diploma or GED required
• Basic accounting skills, knowledge of Excel and other Microsoft Office products.
• Must be available to work Monday-Friday, standard business hours

Principal Accountabilities

• Ensures claim information is complete and accurate by reviewing claims for discrepancies
• Identify potential issues as it relates to coding or insurance requirements and when needed, works with the proper staff member to correct errors
• Monitor claim submission statistics via generated reports
• Follows up with insurance companies on unpaid or rejected claims to determine and resolve any outstanding issues and re-submit corrected claims if necessary
• Investigate, verify, and analyze patient's eligibility results for any medical coverage and obtain proper billing contact information
• Request or obtain documentation where applicable
• Enters information necessary for insurance claims such as client, insurance, provider, as well as diagnosis recommended by LCDC, Licensed Chemical Dependency Counselor, treatment codes and modifiers if applicable.
• Submits insurance claims to clearinghouse or individual insurance companies electronically or via paper
• For clients with coverage by more than one insurer, prepares and submits secondary claims upon processing by primary payer
• Follows HIPAA guidelines in handling patient information
• Contact providers for credentialing and credentialing applications, gather and submit required documentation for credentialing.
• Verify with the insurance company that the credentialing application was received, and follow up with the insurance network on a regular basis until your credentialing is complete and you have a network effective date with a participating provider agreement
• Respond to any requests for additional information that the insurance company may have
• Document all of your follow up activities as you go through the credentialing process
• Review your participating provider contract for details of your requirements as a network provider, claims submission procedures, fee schedule for your services, timely filing limits, and all other important contract terms
• Keep copies of all credentialing applications and contracts submitted. Retain a final copy of any network contracts
• Generate reports for Director
• Performs other duties as assigned.

Other Skills/Experiences

• Strong organizational skills and attention to detail
• Excellent written and verbal communication skills
• Ability to work independently with minimal direction and oversight as well as with a team
• Ability to handle multiple responsibilities under strict deadlines and prioritize efficiently
• Familiarity with HIPAA privacy guidelines and maintains and protects all confidential information

Physical and Mental Requirements

Prolonged periods of using a computer and sitting at a desk. Ability to review and analyze data and effectively communicate with internal and external customers.

Work Environment

Office

Occupational Exposure Category

Minimal

Work Schedule

This position is non-exempt and is eligible for overtime. Typical hours are Mon -Friday 8-5. On occasion may be asked to participate in special events that may occur on the weekend or in the evenings.