Position Title: Medicaid Claims Analyst
FLSA Status: Hourly
Type of Position: Full-time
Department Name: RetroPay
Reports To: RetroPay Team Lead
The Medicaid Claims Analyst is responsible for the submission of clean and timely patient claims to Medicaid and Managed Care Medicaid insurance companies.
ESSENTIAL FUNCTIONS OF THE JOB
- Review assigned reports and correct claims that are on hold or rejected. Note accounts as appropriate.
- Review system reports to identify delinquent accounts.
- Performs insurance verification to determine coverage and benefit eligibility of patient.
- Follow up with insurance to identify reason for non-payment. Take the appropriate and necessary action to have the claim paid.
- Respond promptly to inquiries, concerns and problems related to billing.
- Maintain a positive dialogue and collaborative working environment.
- Maintain thorough and detailed knowledge of Medicaid fee schedules and reimbursement rules for numerous states including but not limited to Florida, Kentucky, Missouri, and North Carolina.
- Exhibit an understanding of federal, state and contractual guidelines/regulations as it relates to Medicare, Medicaid, and Managed Care companies to ensure ongoing compliance.
- Demonstrate thorough knowledge of UB and 1500 electronic and hardcopy billing forms, formats, and filling requirements.
OTHER DUTIES AND RESPONSIBILITIES OF THE JOB
- Exhibit an understanding of CPT, HCPCS, Revenue Codes, ICD-10 diagnosis and procedure coding guidelines.
- Knowledge of HIPAA rules and regulations.
- All other duties as assigned.
SKILLS AND ABILITIES
- Preferred knowledge of medical terminology, CPT/HCPCS/UB04 revenue coding, modifiers, and billing regulations, documentation standards, fee schedules, third party billing and documentation standards.
- An overall knowledge of functions & activities of medical offices/hospitals, understanding of compliance, knowledge of various payment systems, skill in researching and resolving problems and issues
- Strong computer skills with knowledge of Microsoft Outlook, Word, Excel and practice management systems.
- Excellent interpersonal skills and experience interacting with personnel (clinical staff and finance/management/administration).
- Excellent written and oral communication skills.
- Strong team player.
- Adherence to strict confidentiality.
- Able to plan, analyze and prioritize workload.
- Meet deadlines and function independently.
- Five (5) to Seven (7) years experience in Medicaid claims submission, follow-up, and correction for an Outpatient Hospital or Federally Qualified Health Center, preferably in Florida or Kentucky.
- Experience across multiple practice management systems, clearinghouses, and payers strongly preferred.
EDUCATION / CERTIFICATION REQUIREMENTS
- High School Diploma or GED equivalent required.
- Coding Certification a plus.
PHYSICAL REQUIREMENTS ESSENTIAL TO PERFORM THE DUTIES OF THE JOB
- Frequently remains in a sitting position at a desk to perform duties.
- Frequently communicates with co-workers, customers, and contractors/vendors in person, on the telephone, and on the computer.
- Frequently works in a well-lit room.
- Frequently views the computer to perform duties.
- Frequently uses the computer with fingers and hands for documentation and communication.
- Occasionally stoops, bends, or kneels.
- Occasionally exposed to outside elements when traveling for business.
- Occasionally required to push and/or pull objects.
- Occasionally lifts and/or carries objects weighing up to twenty (20) pounds.
- Competitive salary and incentive bonus commensurate with experience along with Fortune 500 level benefits.
To apply send your resume to firstname.lastname@example.org.