Managed Medicaid Specialist

Job Description

Job Description

Medicaid Managed Care Specialist SUMMARY: The Medicaid managed Care Specialist works to review, investigate and follow-up on various insurance claims.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Ensure that established accounting procedures are followed for processing insurance claims
• Checking for accuracy of information for claim submission.
• Monitoring claims processing status, recorded payments and adjustments within the billing system.
• Maintain accurate records, up to date billing systems
• Managing and submitting appeals, calls, emails and other efforts to obtain insurance coverage payment.
• Follow-up on, collect and allocate payments as applicable
• Performing collections follow-up process in accordance with established procedures.
• Research and Resolve denied claims in a timely fashion
• Investigate and resolve customer queries and communicate with customers via phone, email, mail or personally
• Assist with preparation of monthly statements, or as requested by supervisor
• Other duties as assigned

QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements below are representative of the knowledge, skill, and/or ability required.

• Experience in Long Term Care industry, preferred
• Experienced in Managed Medicaid billing
• Experience in Point Click Care (PCC) billing system is preferred

PHYSICAL DEMANDS: The physical demands are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to move intermittently throughout the workday.