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Senior Medicaid Billing and Collections Specialist-2403306
Description
JOB PURPOSE :
Supports the delivery of all Medicaid billing services by final / higher level auditing, correcting, and submitting claims.
Ensures that billing services are timely, accurate, and allow for appropriate reimbursement. Conducts all claims-related follow up on payment delays, taking corrective action(s) to finalize account disposition and / or referring claims to the appropriate staff to ensure appropriate reimbursement in the timeliest manner possible.
Conducts month-end close and cash posting responsibilities for all assigned locations. This position functions within a team environment and under general supervision.
Successful individuals manage a volume of work as established by PruittHealth productivity performance standards, are familiar with the rules and regulations of Medicaid billing and are skilled at problem solving and account resolution.
They work well within a team and help foster an environment where continuous improvement in business processes and services is welcomed and recognized to build a high-performance culture via the standard PruittHealth responsibilities.
KEY RESPONSIBILITIES :
1. Performs all billing and follow-up functions, including the investigation of payment delays resulting from pended claims, with the objective of receiving appropriate reimbursement based upon services delivered and ensuring that the claim is paid / settled in the timeliest manner possible.
2. Works with assigned community services facilities’ administrators and office personnel to manage relevant accounts receivable.
3. Edits claim forms, using proper data element instructions for each payer, applying principles of coordination of benefits, and ensuring that correct diagnosis, and procedure codes are utilized.
4. Submits Medicaid claims, including the maintenance of bill holds and the correction of errors, to provide timely, accurate billing services.
5. Researches claim rejections, making corrections, taking corrective actions and / or referring claims to appropriate staff members for follow through to ensure timely claim resolutions.
6. Conducts account follow up including the investigation of payment delays to appropriately maximize reimbursement based upon services delivered and ensuring claims are paid and settled in the timeliest manner.
7. Applies knowledge of specific payer billing / payment rules, managed care contracts, reimbursement schedules, eligible provider information and other available data and resources to research payment variances, make corrections, and take appropriate corrective actions to ensure timely claim resolutions.
8. Evaluates accounts, resubmits claims, and performs refunds, adjustments, write-offs and / or balance reversals, if charges were improperly billed or if payments were incorrect.
9. Responds to inquiries, complaints or issues regarding patient billing and collections, either directly or by referring the problem to an appropriate resource for resolution.
10. Participates in cross-training and job enlargement opportunities for major job. responsibilities. Works with direct supervisor to identify minor set of responsibilities to develop and perform.
11. Plans, organizes, and documents work to deliver business results by meeting or exceeding all individual operating metrics and service line agreement objectives.
12. Follows all PruittHealth policies and procedures, state and federal laws and regulations and report violations and potential issues to his / her team leader as appropriate.
13. Contributes ideas and actions towards the continuous improvement of Revenue Cycle processes.
14. Adapts to learning new processes, concepts, and skills; Seeks and responds to regular performance feedback from team lead and provides upward feedback, as needed.
15. Assists in orientation and appropriate training of team members, including helping cross-train peers in minor responsibilities and acting as a mentor to peers.
16. Maintains positive work relationships with members of own and other teams to communicate effectively and ensure compliance with cross-team responsibilities.
17. Carries out all duties with a Commitment to Caring attitude in accordance with PruittHealth’s mission, vision, and philosophy.
18. Serves as a lead to facilitate cross-training and job enlargement opportunities for Major job responsibilities for other team members.
19. Serves as the key contact and superuser (, administrative rights to all facilities) for all systems used by team(s) (, MatrixCare, collections module, GAMMIS, DDE, payer portals, Rycan, etc.)
20. Identifies new areas of training for assigned team and / or Revenue Cycle team as a whole, including developing training materials and delivering training as needed
21. Serves as the key contact for training and onboarding for new partners to the team
22. Provides feedback to RFM about individual team members as appropriate (to be clear, all feedback is still to be delivered by RFM and not this position)
23. Serves as back up to RFM in certain situations, including but not limited to :
25. Answer questions and provide guidance when RFM is absent
26. Perform Balance forwards, particularly during periods of increased volume
27. Advanced research on difficult accounts
28. Overflow coverage during team PTO and / or vacancies
29. Active participant / lead in responding to audit / information requests
KNOWLEDGE, SKILLS, ABILITIES :
Billing
Primary Location
Georgia-NORCROSS
Schedule
PRN : Shift
Shift
1st Shift
Job Posting
May 9, 2024, 3 : 34 : 01 PM
Work Locations
PH Finance1626 Jeurgens CourtNorcross30093
Last updated : 2024-05-11
Full Time
Business Services
$62k-85k (estimate)
04/29/2024
08/10/2024
pruitthealth.com
NORCROSS, GA
1,000 - 3,000
1969
Private
NEIL L PRUITT
$1B - $3B
Business Services
PruittHealth provides post-acute care services to patients and their families.
The job skills required for Medicaid specialist include Managed Care, Microsoft Office, Problem Solving, Billing, Communicates Effectively, Time Management, etc. Having related job skills and expertise will give you an advantage when applying to be a Medicaid specialist. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Medicaid specialist. Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Medicaid specialist positions, which can be used as a reference in future career path planning. As a Medicaid specialist, it can be promoted into senior positions as a Managed Care Supervisor that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Medicaid specialist. You can explore the career advancement for a Medicaid specialist below and select your interested title to get hiring information.