Billing Representative

Medicaid Billing Rep Billing Coordinator Full-time M-F

FLSA Status:  Non-exempt

Main Purpose

To ensure the accurate and timely processing of Medicaid billing, accounts receivable management, payment posting, benefit verification, and reimbursement follow-up activities in support of the Agency's financial operations and regulatory compliance.

Essential Functions Medicaid Claims Processing

•   Processes and submits Medicaid Hospice, Medicaid Room & Board, and applicable managed Medicaid claims accurately and within established billing timelines.

•   Processes Medicaid authorizations, making sure paperwork is filled out properly and signed by all appropriate staff members.

•   Reviews claims for accuracy, completeness, and compliance with state Medicaid requirements prior to submission.

•     Posts Medicaid payments and adjustments accurately and timely.

•     Research, resolves, and follows up on denied, rejected, suspended, or unpaid Medicaid claims.

•     Monitors accounts receivable reports and perform timely follow-up on outstanding balances.

•    Maintains documentation necessary to support Medicaid eligibility and reimbursement.

•    Communicates professionally with state Medicaid representatives, Managed Care Organizations (MCOs), providers, hospitals, nursing facilities, and physician offices regarding 

      billing and reimbursement issues.

•     Maintains detailed records of claim status, billing activity, and collection efforts.

•     Assists with audits and reimbursement reviews as requested

Medicaid Eligibility and Benefits Verification

•    Verifies Medicaid eligibility, coverage periods, spend-down requirements, and managed care enrollment.

•    Verifies benefits and payer requirements for Medicaid Managed Care plans and secondary insurance coverage.

•    Collaborates with Referral Specialists, Intake Coordinators, Admissions staff, and Case Managers to ensure accurate eligibility determination.

•     Identifies and resolves eligibility discrepancies prior to admission and throughout the patient's episode of care.

•     Documents verification details accurately within designated software and related systems.

•    Communicates coverage information and authorization requirements to appropriate staff members.

•     Monitors Medicaid approval, pending, and redetermination statuses as applicable

Medicaid Notifications and Authorizations

•         Reviews and monitors Medicaid notifications, approvals, denials, and eligibility determination notices.

•         Tracks required authorization, level-of-care determinations, and Medicaid approval documentation.

•         Scans and files Medicaid notification letters and supporting documentation into the electronic medical record.

•         Works with Admissions, Clinical Staff, and State Agencies to obtain required documentation for reimbursement.

•         Maintains records of Medicaid approvals, discharge notifications, and regulatory reporting requirements.

Accounts Receivable Management

•          Performs follow-up on unpaid or underpaid Medicaid claims.

•          Maintains claim appeals and supporting documentation for denied claims.

•          Identifies billing trends, reimbursement issues, and recurring claim errors.

•          Communicates reimbursement concerns and recommendations to management.

•          Collaborates with Clinical and Finance staff to resolve documentation deficiencies impacting payment.

Administrative Duties

•         Supports the Agency's commitment to preventing fraud, waste, and abuse.
•         Maintains knowledge of hospice philosophy and applicable federal, state, and payer regulations.
•         Maintains Medicaid tracking and reimbursements.
•         Arrivals at work and meetings prepared and on time.
•         Attends required educational programs and continuing education opportunities.
•         Demonstrates flexibility and adaptability in response to changing organizational needs and regulatory requirements.
•         Works effectively under time constraints while maintaining quality and accuracy standards.
•         Promotes positive working relationships with patients, families, referral sources, and colleagues.
•         Supports the Agency's mission, vision, values, and culture.
• •         Performs other related duties as assigned.

Compliance and Confidentiality

•    Adheres to all Medicaid, Medicaid, HIPAA, and other applicable federal and state regulations. 
•    Maintains confidentiality and safeguards protected health information.
•    Follows Agency policies, compliance with standards, and reporting requirements
•    Participates in compliance education and billing audits as required

Physical and Mental Requirements

The employee must be able to:

•      Communicate effectively in English through verbal and written communication.

•      Hear and understand normal conversations in person and by telephone.

•      See with sufficient visual acuity to review records, computer screens, and documentation.

•      Use hands, wrists, and fingers continuously for typing, writing, data entry, and operation of office equipment.

•      Sit for extended periods while performing computer-based work.

•      Maintain concentration, accuracy, and attention to detail in a fast-paced environment.

•       Manage multiple priorities and deadlines effectively.

Qualifications Education

•      High School Diploma or equivalent required.

•      Postsecondary coursework in Medical Billing, Coding, Health Information Management, or related field preferred.

Experience

•      Minimum of three (3) years of experience working with Medicaid billing and reimbursement.

•      Knowledge of hospice billing practices is strongly preferred.

•      Experience with Medicaid and commercial insurance billing is preferred.

•      Experience working with electronic health records and billing software required.

       Experience with claims follow-up, denial management, and accounts receivable processes preferred.

Knowledge, Skills, and Abilities

•      Strong understanding of Medicaid regulations claims processing, and reimbursement guidelines.

•      Strong computer skills, including proficiency with Microsoft Office applications and billing systems.

•      Excellent organizational and time management skills.

•      Ability to prioritize workload and meet deadlines.

•      Strong analytical and problem-solving abilities.

•      Excellent verbal and written communication skills.

•      Ability to maintain confidentiality and professionalism.

•      Ability to work independently and collaboratively within a team environment.

•      Strong attention to detail and commitment to accuracy