Medicaid Specialist, 250 E. Liberty, 8:00a-4:30p

Job Title

This position requires thorough knowledge of the Uniform Bill, Medicaid, Medicare and Medicare Advantage billing, secondary deductible/coinsurance billing, and the Direct Data Entry (DDE) system for follow up.

Job Description

The specialist performs all duties related to timely and efficient billing and follow-up using their thorough understanding of Medicaid eligibility, benefits, determining primary payer, and covered benefits.

Essential Functions:

• Monitors and resolves claims holding on discharged not final billed (DNFB) list
• Ensures claims are filed electronically except for specified paper claims
• Identifies payers being submitted on paper rather than electronically and communicate the opportunities to leadership
• Follows up on unpaid Medicaid claims in a timely manner
• Ensures high-dollar accounts have consistent follow up until the account has been resolved
• Responsible for reviewing and understanding explanation of benefits/remittance advice
• Ensures statements are generated for the patient responsibility amounts
• Utilizes insurance websites to view and resolve claims
• Performs extensive account follow-up and provide analysis of problem accounts
• Documents all follow up efforts in a clear and concise manner into the AR system
• Submits shadow claims for inpatient payers
• Audits and researches accounts, payment postings and contractual to confirm the accuracy of the balance of the account
• Adheres to CMS guidelines for coordination of payment/coverage with all other appropriate payers
• Ensures medical record requests are documented and submitted in a timely manner
• Phone contacts with patient, physician office, attorney, etc. for additional information to process claims

Other Functions:

• Maintains familiarity with inpatient-only procedure list and works with Revenue Cycle leadership to prevent denials
• Identifies and reports all trends that may provide insight into payment challenges
• Works on assigned accounts as directed while reaching daily productivity goals
• Completes tasks by deadline
• Attends seminars as requested
• Maintains compliance with all company policies, procedures and standards of conduct
• Complies with HIPAA privacy and security requirements to maintain confidentiality at all times
• Performs other duties as assigned

Job Requirements

Education: High School Diploma or GED/Equivalent (required) Experience: One (1) year of patient registration, billing or equivalent experience (required) Working knowledge of medical and insurance terms (preferred)

Job Competency: Knowledge, Skills, and Abilities critical to this role: Ability to review, comprehend, discuss HCFA billing with Insurance or Government agencies Knowledge of general insurance requirements Experience working directly with EOBs and contractual adjustments General computer knowledge, working with electronic filing Ability to communicate verbally/in writing with professionalism Ability to meet productivity expectations

Language Ability: Must be able to communicate effectively in both verbal and written formats

Reasoning Ability: Ability to break down problems or tasks; using prior knowledge and experience to identify causes and consequences of events Computer Skills: General computer knowledge Must have the ability to learn and use relevant systems appropriately

Additional Responsibilities: Demonstrates a commitment to service, organization values and professionalism through appropriate conduct and demeanor at all times Maintains confidentiality and protects sensitive data at all times Adheres to organizational and department specific safety standards and guidelines Works collaboratively and supports efforts of team members Demonstrates exceptional customer service and interacts effectively with physicians, patients, residents, visitors, staff and the broader health care community

UofL Health Core Expectation: At UofL Health, we expect all our employees to live the values of honesty, integrity and compassion and demonstrate these values in their interactions with others and as they deliver excellent patient care by: Honoring and caring for the dignity of all persons in mind, body, and spirit Ensuring the highest quality of care for those we serve Working together as a team to achieve our goals Improving continuously by listening, and asking for and responding to feedback Seeking new and better ways to meet the needs of those we serve Using our resources wisely Understanding how each of our roles contributes to the success of UofL Health