Medicaid Pending Billing Specialist

Role Description

The Medicaid Pending Billing Specialist at POLARIS PHARMACY SERVICES is responsible for managing the billing process for Medicaid pending claims, ensuring timely resolution and rebilling. This role requires a detail-oriented professional who can effectively liaise with various stakeholders to facilitate appeals and provide financial assistance, while maintaining accurate documentation throughout the process.

• Manage the pending queue for Medicaid claims, ensuring all claims are processed efficiently and accurately.
• Resolve claim issues by identifying discrepancies and implementing solutions to facilitate timely payments.
• Rebill Medicaid claims as necessary, ensuring compliance with relevant regulations and guidelines.
• Serve as a liaison between POLARIS PHARMACY SERVICES and Medicaid representatives, facilitating communication and resolution of billing issues.
• Handle appeals processes, working to overturn denied claims and secure payment.
• Provide financial assistance guidance to patients and families, helping them navigate the complexities of Medicaid billing.
• Maintain thorough and accurate documentation of all billing activities, ensuring records are up-to-date and accessible for auditing and reporting purposes.

Qualifications

• Strong knowledge of Medicaid billing procedures and regulations.
• Excellent organizational skills with the ability to manage multiple tasks and priorities effectively.
• Proficiency in using billing software and Microsoft Office Suite, including Excel and Word.
• Strong analytical skills with attention to detail in documentation and claim resolution.
• Effective communication skills to liaise with various stakeholders, including patients, insurance companies, and internal departments.
• Ability to work independently and collaboratively in a fast-paced environment.
• Problem-solving skills with a proactive approach to resolving billing issues and claims efficiently.

Requirements

• High school diploma or equivalent; an associate or bachelor's degree in healthcare administration, finance, or a related field is preferred.
• Minimum of 2 years of experience in medical billing, preferably with Medicaid.
• Proven experience in managing pending queues and resolving claims.
• Experience in working with financial assistance programs and understanding of appeals processes.

Benefits

• Medical, Dental, and Vision insurance.
• 401 (k) (available for Part Time & Full Time EEs).
• Company Paid Life insurance.
• Short-term and Long-term disability insurance.
• Tuition reimbursement.
• Personal Time Off (PTO).
• Competitive pay with annual performance reviews and merit-based raises.
• Career growth potential.
• Annual on-site voluntary Flu Vaccines.
• Employee referral bonus program.