Medicaid Billing Specialist

DEPARTMENT

Billing

LOCATION

Somerville, Mass.

EDUCATION

Any

EXPERIENCE

2+ years

JOB DESCRIPTION

The Medicaid Billing Specialist is responsible for billing all Medicaid trips and maintaining the Medicaid Aging reports. Specialist will handle all incoming member and provider correspondence, denials, appeals and grievances, etc. Determines appropriate classification of each request, performs accurate data entry and conducts initial processing and assignment of the requests. Initiates, reviews, retains and maintains all internal and external controlled documents, and inputs data into a computer processing system. Adheres to all regulatory requirements and operating procedures.

JOB ENVIRONMENT

Normal office environment. A fast paced environment with multi-tasking, prioritizing, and frequent interruptions. Continuous interpersonal communication required with managers, staff, patients, EMS personnel and the general public. Interaction with CMS and NGS Customer Service Department during their hours of operation.

PHYSICAL DEMANDS

Requires sitting and standing associated with a normal office environment. Manual dexterity needed for using a calculator and computer keyboard. This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, skills and working conditions may change as needs evolve.

RESPONSIBILITIES

  • Responsible for intake of grievances/appeals received through customer call centers, mail, email and fax. Route misdirected information to correct staff for timely and appropriate action;
  • Handling and processing all correspondence such as but not limited to denials, appeals, ALJ’s in a timely manner;
  • Assists in gathering comprehensive documentation as needed, from varied internal and external sources relevant to issue raised in grievance/appeal;
  • Conducts research by speaking with members and providers, reviewing member’s records and benefit plan and obtaining responses from various business areas;
  • Assists team in billing/documenting/updating cases in tracking database and other member information, maintain accurate grievance/appeal records;
  • Demonstrates ability to identify complex information and deliver the information both verbally and written, in a professional, clear, concise and articulate manner;
  • Maintains filing system and ensure all files are stored timely and accurately both electronically and hard copy;
  • Requires excellent interpersonal skills in order to communicate and work with multiple constituents and be able to recognize sensitive issues and when to escalate to Management;
  • Must have a thorough understanding of health plan operations and business unit processes, work flows and system requirements, including but not limited to, authorizations, billing, claims and regulatory compliance and plan benefits;
  • Ensures the timely and accurate documentation, review, routing and tracking of member issues in compliance with regulations established by external regulating bodies such as CMS and applicable state and federal laws;
  • Handles multiple issues and prioritizes appropriately with the ability to organize work to meet deadlines;
  • Prepares case files for Independent Review Entities that are well organized, contain relevant documentation and are processed within the required time frames;
  • Maintains corporate policies and procedures and other formal documents pertinent to the complaint, grievance and appeal function;
  • Other duties as assigned.

 

QUALIFICATIONS

  • Strong communication (written/oral), and organization skills with great level of attention to detail;
  • Ability to interpret medical terminology, regulations/statutes and apply them without direct supervision;
  • Experience in 2+ years in relevant billing;
  • NAAC Certified Ambulance Coder (CAC);
  • Must have full knowledge of Medicaid and Medicare manual;
  • Exceptional presentation skills;
  • Knowledge of Microsoft Office, Outlook, ZOLL and relational databases.

 

The above are intended to describe the general nature and level of the work being performed by the person/people in this position. This is not an exhaustive list of all duties, responsibilities, knowledge, skills, and abilities associated with this position. Cataldo Ambulance is an Equal Opportunity / Affirmative Action Employer All qualified applicants will receive consideration for employment without regard to disability, race, color, veteran status, religion, sex, or national origin. Individuals with Disabilities and Veterans are encouraged to apply.

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