Claims Representative (Medicaid Specialist)): Lee Agency/Brighton Consulting Group

Job Description

Job Description

Salary:

Brighton Consulting Group (BCG), a Lee Agency Company

This role will require commuting to Coralville, Iowa for training (typically 3-6 months), then transitioning to a permanent onsite office location in Muscatine, Iowa.

Company Overview:

Supporting Iowa providers of long-term care in enhancing the quality of life for those in their service.

Our mission centers on delivering professional and technical consulting services with high standards of professionalism and integrity in our relationships with clients and others.

Position Summary:

Manage all aspects of the Medicaid claims submission and collection relating to clients health care services, client communication, and customer service.

General Job Duties:

• All employees are responsible for a basic knowledge of the employee handbook and must conduct themselves with behavior that supports these values.
• All employees are responsible for making the most of their working time and reach maximum potential by being on time for appointments, checking voicemails/emails as appropriate, and completing deadlines in a timely manner.
• All employees are expected to escalate issues as necessary.
• All employees will specifically be trained on their job duties, however; other mandatory trainings may be deemed appropriate by management for one or all members of the team.
• All employees must occasionally collaborate with the leadership team to create, revise, and maintain accurate job descriptions.
• All employees must keep client information confidential and in accordance with regulations.

Essential Job Functions:

• Manage client Medicaid, hospice, and waiver claims by ensuring compliance with regulatory requirements, qualifications, and contracted rates.
• Maintain extreme levels of accuracy, targeting 98% collection rate.
• Initiate follow-up communication with MCOs and/or clients to ensure resolution of issues.
• Coordinate with Department of Human Services (DHS) MCO Liaison and/or the Iowa Healthcare Association (IHCA) Managed Care Specialist in resolution of issues.
• Ensure all hospice and out-of-state Medicaid claims are submitted by the 5th working day of the month or within 2 days of receiving information from a client if received after the 5th working day.
• Verify MCO assignments are accurate for billing.
• Conduct research on billing requirements with Centers of Medicare and Medicaid Services.
• Communicate with new Medicaid/MCO billing clients on initial setup for claims submission and remittance retrieval.
• Conduct yourself professionally with clients and other team members at all times. Escalate customer and/or account concerns to your direct supervisor. Ensure the highest level of customer service possible.
• Complete client education and relationship building as needed.
• Assist as needed with new provider contracts and other projects as assigned.
• This position is responsible for cross training with Claims and Accounts Receivable roles to the point of covering their roles during times of absence.

Position Requirements:

The requirements listed below are representative of the knowledge skills and abilities required. Employees who do not possess the requirements for a job at the time of hire will not be considered for the position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Required Skills and Experience:

• Capable of working effectively independently and in a team environment
• Must be self-motivated, goal and detail oriented
• Flexible and adaptable to changing work environment
• Ability to prioritize multiple tasks and manage time efficiently
• Communicate in a positive manner with clients and escalate any issues and/or messages to the leadership team
• Basic proficiency in computer skills and financial duties pertaining to business operations
• Flexibility pertaining to client needs and requests

Desired Skills and Experience:

• Wellsky Software
• Experience with HIPPA compliance and PHI
• Working with insurance or healthcare administration/billing
• Medical or clinical background, preference given to long-term care experience
• An Associate Degree in Accounting or similar field or relevant work experience

Language Requirements:

The primary language of Brighton Consulting Group is English. Excellent communication skills are defined as the ability to:

• Actively listen for total comprehension
• Ask questions that enhance the understanding of a certain topic
• Relay information and/or instruction in a descriptive and understandable fashion in both written and verbal forms

Physical Requirements:

Occasional lifting up to 20 lbs. may be necessary from time to time. Must be able to sit for long periods of time, use fine motor skills, have the ability to view a computer monitor, and type (up to 8 hours a day). Additionally, there may be exposure to moderate noise levels due to the office functions (i.e. talking, printing, copying, etc.)

FLSA Status:

Non-exempt/Hourly: This position is paid an hourly rate and therefore is eligible for 1.5 times the normal wage for every hour over 40 worked in a given work week. Overtime must be preapproved by your supervisor.

Employment Status:

Full time: This position at BCG requires at least 40 hours a week. Occasionally, time over 40 hours may be necessary to meet the requirements of the position. Full-time employees are eligible for employee benefits.

Supervision Requirements:

This position supervises: None.

This position reports to: Accounts Receivable Supervisor.