Description

Under the general supervision of the Director of Navigation & Accounts, this position performs complex clerical and administrative duties supporting program operations and other designated staff as appropriate.

This is sedentary work requiring the exertion of 10 pounds of force occasionally to move objects; work requires stooping, reaching, walking, and lifting; vocal communication is required; hearing is required to perceive information at normal spoken word levels; visual acuity is required for preparing and analyzing written information. No supervisory requirements.

JOB DUTIES  

• Performs client data entry to include billable services, client payments, Medicaid/Insurance status, and prior authorizations (PA).
• Determines eligibility status of Medicaid and Insurance clients. Aggressively pursues other resources available through third party insurance to ensure payment for services performed.
• Obtains MCO prior authorization (PA). Maintains PA expirations and follows up with staff. Responsibility for resolving discrepancies and assisting the Agency in the Medicaid compliance requirements.
• Prepares and submits Medicaid and Insurance claims.
• Processes Explanation of Benefits (EOBs), remittance advices, and provides appropriate information to rectify discrepancies if necessary.
• Works all RCM and CareLogic errors daily.
• Meets with clients concerning payment agreements and billing issues.
• Verifies accuracy of monthly client billing and processes the mailing of client statements, including processing of any returned mail.
• Scans and attaches documents into electronic health record as needed.
• Assists with GEAR and Debt Set-off submission and collections.
• Performs related duties as assigned.
• Attends related state Medicaid and other trainings as required.
• Serves on Agency committee(s) as requested.
• Actively supports a diverse, equitable and inclusive work environment as demonstrated in the 5 core values of acknowledgement, commitment, openness, celebration and humility.
• Actively support a trauma informed and responsive work environment as demonstrated in the 5 core values of safety, trustworthiness, choice, collaboration, and empowerment.
• Performs related duties as required.

REQUIRED KNOWLEDGE, SKILLS, AND ABILITIES:

Ability to communicate effectively in oral and written form

Knowledge of client confidentiality as related to client records

Knowledge of office management practices and procedures

Familiarity with menu driven software applications

Ability to compose and prepare accurate reports, records summary and correspondence

Ability to work effectively with public in giving and obtaining information

Qualifications

An Associate Degree in Administrative Office Technology and two years demonstrated Insurance billing experience; HS diploma and three-five years Insurance billing experience; or any equivalent combination of training and experience required. Must be able to pass basic computer skills testing. Experience with eMedix and Availity preferred. Ability to communicate in Spanish is highly desired.