Revenue Specialist, Medicaid

Position Summary

The Revenue Specialist, Medicaid ensures proper submission and adjudication of all claims submitted to Medicaid carriers while working within the deadlines and protocols of the assignments. This position is responsible for handling patient health information (PHI) and maintaining extreme privacy and security as it relates to confidential and proprietary information.

Key Responsibilities

• Verify patient eligibility when needed.
• Analyze and evaluate Medicaid claim payments using the company’s systems and tools. Use payment documentation provided by payers to determine if the medical provider has been reimbursed in compliance with the applicable state fee schedule.
• Research, request and acquire all pertinent medical records and any other supporting documentation necessary and then submit with hospital claims to ensure prompt correct claims reimbursement.
• Review technical billing (UB 04) components provided by Client Hospital for accuracy. Make necessary changes as required in accordance with billing laws.
• Conduct timely and thorough telephone follow-up with payers to ensure claims with supporting documentation have been received and facilitate prompt reimbursement.
• Prepare correct Medicaid initial bill packet using EnableComp systems’ tools and submit with all necessary supporting documentation to insurance companies
• Analyze all assigned account delinquencies and account activity to ensure timely and accurate payments from appropriate payers.
• Work with insurers and outside entities through various avenues to verify/request authorizations and assist in concurrent review activities to obtain authorization as needed.
• File and handle confidential documentation and patient health information (PHI); adhere and follow all HIPAA mandated guidelines.
• Manage both inbound and outbound calls efficiently and effectively.
• Assist in efficiently moving work through the department, working as part of a team.
• Appeal claim denials and/or underpayments as necessary.
• Other duties as required

Requirements and Qualifications

• High School Diploma or GED required. Associates or Bachelor’s Degree preferred.
• 1-2+ years’ experience in healthcare field working in billing or collections.
• 1+ years’ client facing/customer services experience.
• 1+ years’ experience with UB-04 billing and collections required. CMS-1500 billing and other complex claims experience a plus.
• Intermediate level understanding of insurance payer/provider claims processing and subsequent data requirements.
• Intermediate level understanding of Medicaid payers preferred.
• Equivalent combination of education and experience will be considered.
• Must have strong computer proficiency and understand how to use basic office applications, including MS Office (Word, Excel, and Outlook).
• Regular and predictable attendance.
• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.

Special Considerations and Prerequisites

• Practices and adheres to EnableComp’s Core Values, Vision and Mission.
• Proven ability to meet and/or exceed productivity targets and goals.
• Maintains stable performance under pressure or opposition. Handles stress in ways to maintain relationships with all stakeholders.
• Must be a self-starter and able to work independently without direct supervision.
• Proven written and verbal communication skills.
• Strong analytical and problem-solving skills.
• Proven experience working with external clients; strong customer service skills and business acumen.
• Ability to prioritize and manage multiple competing priorities and projects concurrently.
• Must be able to remain in stationary position 50% of the time.
• Occasionally moves about inside the office to access office equipment, etc.
• Constantly operates a computer and other office equipment such as a copy/scan/print machine, phone and computer.