Job Posting OPEN
Medicaid Billing Specialist
Position: Medicaid Billing Specialist
Department: Administration
Reports
to: Fiscal
Director
Status: Full-time, Non-Exempt
Schedule: Monday through Friday 8am-4pm;
37.5 hours per week
Wage
Range: $18.00
– $20.00
Job
Function: Responsible
for the review, preparation, and follow-up of billing claims for CAPCO’s
Consumer-Directed Services Program (CDPAP), including Medicaid managed care billing
for CDPAP.
Primary Duties and
Responsibilities
include the following. Other duties may be assigned.
- Prepares, reviews, and enters electronic and
manual billing claims to Medicaid managed care carriers and other third-party
payers timely and accurately and in accordance with all rules and
regulations.
- Conducts thorough audit review of billing
claims prepared by Consumer-Directed Services (CDS) department, working to
resolve issues with claims before submission.
- Ensures all billing documentation is
complete and accurate for claim submission.
- Monitors and follows-up on all claim remittance
statuses to ensure timely and full payment of claims.
- Initiates review of claim remittance
reports to identify payment denials for review and resubmission.
- Works closely with CDS department staff to
resolve issues associated with claim denials and to correct errors for claim
re-billings.
- Works with CDS department
to perform appropriate analysis, research, and other collection activities
to follow-up on non-adjudicated claims, including contacting Medicaid
carrier representatives and other payers as necessary.
- Prepares claim re-billing
submissions with all proper documentation.
- Serves as central point for maintaining
submitted billing files.
- Works with supervisor and
CDS department to identify and resolve trends when claims are denied and
implements approved process changes as needed.
- Functions as a resource
to fellow colleagues when questions or issues arise and works closely with
the CDS department to identify process flows and resolve issues accurately
and promptly.
- Work efficiently and
accurately within billing software platforms, continuously developing knowledge
of systems to review output and identify necessary changes for accurate
claim submissions.
- Maintains working knowledge of Medicaid billing
regulations and third-party insurance/payer requirements, participating in
relevant professional development trainings.
- Performs other Fiscal department tasks and
projects assigned by the supervisor.
Qualifications and Requirements: High School Diploma or equivalency required; Associate
degree in related field preferred; plus 1-3 years’ experience; or equivalent
combination of education and experience.
CAPCO is an Equal
Opportunity Employer and we do not discriminate against employees or applicants
for employment on any legally recognized basis including, but not limited to:
veteran status, uniform service member status, race, color, religion, sex, sexual
orientation, age, and physical or mental disability. CAPCO will make reasonable
accommodations for qualified candidates in adherence of the Americans with Disabilities
Act and New York Human Rights Act.
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