Job Title : Medicaid Billing Specialist

Reports to : Controller

FLSA : Exempt

Work Location : In Person

Job Summary :

As the Medicade Billing Specialist, you will be responsible for overseeing and managing the accounts receivable functions and Medicaid billing for the orginization.

This role involves supervising a team of professionals, ensuring timely and accurate invoicing, collections, and reconciliation of accounts.

The ideal candidate will possess strong leadership skills, attention to detail, and a thorough understanding of accounting principles and practices.

Responsibilities :

Develop and implement policies and procedures for the accounts receivable department to optimize efficiency and minimize errors.

Monitor accounts receivable aging reports and take appropriate actions to ensure timely collection of outstanding invoices.

Collaborate with sales and customer service teams to resolve billing discrepancies and address customer inquiries or disputes in a timely manner.

Conduct regular reconciliations of accounts receivable ledger to ensure accuracy and completeness of records.

Prepare monthly, quarterly, and annual reports on accounts receivable performance, including aging analysis, bad debt provision, and cash forecasting.

Stay informed about changes in accounting regulations and best practices related to accounts receivable management, and ensure compliance with relevant standards.

Continuously assess and improve accounts receivable processes and systems to enhance efficiency and effectiveness.

Develop and implement billing policies, procedures, and best practices to ensure accuracy, efficiency, and compliance with regulations.

Oversee the invoicing process, ensuring timely and accurate generation and delivery of invoices to clients or customers.

Monitor accounts receivable aging reports and follow up on overdue accounts to expedite payment and minimize delinquency.

Investigate and resolve billing discrepancies or disputes promptly and professionally, coordinating with relevant departments as needed.

Collaborate with Sales, Customer Service, and Operations teams to address billing inquiries and provide excellent customer support.

Analyze billing data and financial reports to identify trends, discrepancies, or areas for improvement, and make recommendations to management.

Maintain up-to-date knowledge of billing software systems and implement upgrades or enhancements as necessary.

Prepare regular reports and presentations for management on billing performance, key metrics, and strategic initiatives.

Review and analyze patient medical records and encounter forms to accurately code and bill Medicaid claims according to CMS guidelines.

Prepare and submit electronic and paper Medicaid claims for services rendered, including inpatient, outpatient, and durable medical equipment (DME) services.

Verify patient eligibility, coverage, and benefits with Medicaid and other payers to ensure accurate billing and reimbursement.

Monitor claim status and follow up on outstanding or denied claims, appealing rejected claims and resubmitting corrected claims as needed.

Stay up-to-date on changes to Medicaid regulations, coding guidelines, and reimbursement policies, and ensure compliance with all applicable requirements.

Maintain accurate records and documentation of all Medicaid billing activities, including claim submissions, payments, and appeals.

Communicate effectively with internal stakeholders, government agencies, and insurance representatives to resolve billing inquiries, address compliance issues, and facilitate timely reimbursement.

QUALIFICATIONS :

High school diploma or equivalent required; Associate's or Bachelor's degree in Healthcare Administration, Medical Billing and Coding, or related field preferred.

Proven experience in accounts receivable management, with a minimum of 5 years in a supervisory role.

Proficiency in accounting software and Microsoft Excel. Experience with ERP systems (e.g., SAP, Oracle) is a plus.

Excellent communication and interpersonal skills, with the ability to interact effectively with internal and external stakeholders.

Strong analytical and problem-solving abilities, with a keen attention to detail.

Ability to prioritize tasks and manage multiple deadlines in a fast-paced environment.

Leadership skills, including the ability to motivate and mentor team members to achieve departmental goals.

Solid understanding of credit and collections processes, including risk assessment and mitigation strategies.

High level of integrity and professionalism, with a commitment to maintaining confidentiality and ethical standards in financial operations.

5 years of experience working in medical billing or revenue cycle management, with a focus on Medicaid billing and reimbursement.

In-depth knowledge of Medicaid billing rules, regulations, and coding guidelines, including CPT, HCPCS, and ICD-10 coding across multiple states

GENERAL

Adhere to all Bickford policies and procedures.

Work flexible hours to meet the requirements of the job.

Complete other duties as assigned.

LANGUAGE SKILLS

Ability to read, analyze and interpret documents such as regulations, policies, journals, financial reports, and legal documents.

Ability to read and write detailed reports, business correspondence, and procedure manuals in English. Ability to effectively respond to inquiries from clients, families, BFMs, and members of the community.

Ability to use computers. Ability to effectively communicate in one-on-one and small group situations as well as make presentations.

MATHEMATICAL SKILLS

Ability to calculate figures and amounts such as probability, discounts, interest, proportions, and percentages. Ability to apply concepts such as addition, subtraction, multiplication, division, fractions, percentages, and ratios to practical situations.

REASONING ABILITY

Ability to solve practical problems and deal with a variety of variables in situations where only limited standardization exists.

Ability to apply common sense or interpret various instructions furnished in written oral, diagram, or schedule form.

CERTIFICATES, LICENSES, REGISTRATIONS

A valid driver’s license and a driving record that is consistent with Bickford’s insurance carrier guidelines.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by a BFM to successfully perform the essential functions of this job.

Reasonable accommodation may be made to enable individuals with disabilities to perform essential functions.

While performing the duties of this job, the BFM is frequently required to walk, sit, stand, talk, hear, taste, and smell.

The BFM is occasionally required to use hands to finger, handle, or feel; reach with hands and arms; climb or balance; stoop, kneel, crouch, or crawl.

The BFM must frequently lift, move, push, and / or pull up to 25 pounds and occasionally lift, move, push, and / or pull up to 50 pounds.

Specific vision abilities required by this job include close vision, peripheral vision, and the ability to adjust focus.

The BFM must be willing to travel and experience overnight stays and possible weekend work.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those a BFM encounters while performing the essential functions of this job.

Reasonable accommodation may be made to enable individuals with disabilities to perform essential functions.

While performing the duties of this job, the BFM is occasionally exposed to outside weather conditions. The noise level in the work environment is usually moderate.

Disclaimer :

This description is designed to indicate the general nature and level of work for this position. It is not intended to describe minor duties or other responsibilities that may be periodically assigned.

Last updated : 2024-04-30