Medicaid Billing Specialist

Billing SpecialistBasic 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 processesKnowledgeable on insurance billing, collections, and reimbursement processesHigh school diploma or GED requiredBasic accounting skills, knowledge of Excel and other Microsoft Office products.Must be available to work Monday-Friday, standard business hoursPrincipal Accountabilities:Ensures claim information is complete and accurate by reviewing claims for discrepanciesIdentify potential issues as it relates to coding or insurance requirements and when needed, works with the proper staff member to correct errorsMonitor claim submission statistics via generated reportsFollows up with insurance companies on unpaid or rejected claims to determine and resolve any outstanding issues and re-submit corrected claims if necessaryInvestigate, verify, and analyze patient's eligibility results for any medical coverage and obtain proper billing contact informationRequest or obtain documentation where applicableEnters 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 paperFor clients with coverage by more than one insurer, prepares and submits secondary claims upon processing by primary payerFollows HIPAA guidelines in handling patient informationContact 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 agreementRespond to any requests for additional information that the insurance company may haveDocument all of your follow up activities as you go through the credentialing processReview 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 termsKeep copies of all credentialing applications and contracts submitted. Retain a final copy of any network contractsGenerate reports for DirectorPerforms other duties as assigned.Other Skills/Experiences:Strong organizational skills and attention to detailExcellent written and verbal communication skillsAbility to work independently with minimal direction and oversight as well as with a teamAbility to handle multiple responsibilities under strict deadlines and prioritize efficientlyFamiliarity with HIPAA privacy guidelines and maintains and protects all confidential informationPhysical 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: OfficeOccupational Exposure Category: MinimalWork 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.