Billing Representative

Location 501 Comfort Place,Mishawaka, IN, 46545,United States Employee Type 5Days/8Hrs Not a Remote position FLSAStatus: Non- exempt Main Purpose ToensuretheaccurateandtimelyprocessingofMedicaidbilling, accountsreceivablemanagement, paymentposting,benefitverification,andreimbursementfollow-upactivitiesinsupportoftheAgency's financial operations and regulatorycompliance. EssentialFunctions MedicaidClaimsProcessing Processes and submits Medicaid Hospice, Medicaid Room & Board, and applicable managed Medicaid claims accurately and within established billing timelines. Processes Medicaidauthorizations, making sure paperwork is filledoutproperlyand signed byall appropriate staff members. Reviewsclaimsforaccuracy, completeness, andcompliancewithstateMedicaidrequirementsprior to submission. Research,resolves,andfollowsupondenied,rejected,suspended,orunpaidMedicaid claims. Monitorsaccountsreceivable reports andperformtimelyfollow-uponoutstanding balances. Communicates professionally with state Medicaidrepresentatives, Managed Care Organizations (MCOs), providers, hospitals, nursing facilities, and physicianoffices regarding billing and reimbursement issues. Assistswithauditsandreimbursementreviewsas requested Verifies Medicaid eligibility, coverage periods, spend-down requirements, andmanagedcare enrollment. Verifies benefits and payer requirements for MedicaidManaged Care plansand secondary insurance coverage. Collaborateswith ReferralSpecialists, IntakeCoordinators,Admissionsstaff,andCaseManagersto ensure accurate eligibility determination. Identifies and resolveseligibility discrepancies prior toadmission andthroughoutthepatient's episode of care. Documentsverificationdetailsaccuratelywithindesignatedsoftwareandrelated systems. Communicates coverage information and authorization requirements to appropriate staff members. Medicaid Notifications and Authorizations ReviewsandmonitorsMedicaidnotifications,approvals,denials,andeligibility determinationnotices. Tracks required authorization, level-of-care determinations, and Medicaid approval documentation. ScansandfilesMedicaidnotificationlettersandsupportingdocumentationintothe electronic medical record. WorkswithAdmissions,ClinicalStaff,andStateAgenciestoobtain required documentationfor reimbursement. AccountsReceivable Management Performs follow-up on unpaid or underpaid Medicaid claims. Communicates reimbursement concerns and recommendations to management. Collaborates with Clinical and Finance staff to resolve documentation deficiencies impactingpayment. Administrative Duties SupportstheAgency's commitmenttopreventing fraud,waste,and abuse. Maintainsknowledgeofhospicephilosophyandapplicablefederal,state,andpayer regulations. Arrivalsatworkandmeetingspreparedandon time. Attends required educational programs and continuing education opportunities. Demonstratesflexibilityandadaptabilityinresponsetochangingorganizationalneedsandregulatoryrequirements. Promotespositiveworkingrelationshipswithpatients,families,referralsources,and colleagues. Performs otherrelateddutiesas assigned. Compliance and Confidentiality Adheres toall Medicaid, Medicaid,HIPAA, andotherapplicablefederaland state regulations. Maintains confidentiality and safeguards protected health information. F ollows Agency policies, compliance with standards, and reporting requirements Participatesincomplianceeducationandbillingauditsasrequired Physicaland Mental Requirements Theemployeemustbeable to: Communicate effectively in English through verbal and written communication. Hearandunderstandnormalconversationsinpersonandby telephone. Seewithsufficientvisualacuitytoreviewrecords,computerscreens,and documentation. Usehands,wrists,andfingerscontinuouslyfortyping,writing,dataentry,and operationof officeequipment. Sit for extended periods while performing computer-based work. Qualifications Education Postsecondary courseworkin Medical Billing, Coding, Health Information Management, or related field preferred. Experience Minimumofthree(3)yearsofexperienceworkingwithMedicaidbillingand reimbursement. Knowledgeof hospice billing practices is strongly preferred. Experience with Medicaid and commercial insurance billing is preferred. Experience working with electronic health records and billing software required. Experiencewithclaimsfollow-up,denialmanagement,andaccountsreceivableprocesses preferred. Knowledge, Skills, and Abilities StrongunderstandingofMedicaidregulationsclaimsprocessing,andreimbursement guidelines. Strong computer skills, including proficiency with Microsoft Office applications and billing systems. Excellent organizational and time management skills. Ability to prioritize workload and meet deadlines. Excellent verbal and written communication skills. Ability to maintain confidentiality and professionalism. Abilitytoworkindependentlyandcollaborativelywithinateam environment. #J-18808-Ljbffr American RENOLIT Corporation