Medicaid Collections Billing Specialist

About the role

Medicaid Collections Billing Specialist is responsible for the review, edits, submission and collection of both electronic and paper claim submissions for state Medicaid programs and works in conjunction with the Authorization Department. This is a work‑from‑home position that requires you to live and perform the duties within 60 miles of an HCA Healthcare Hospital (located in FL, GA, ID, KS, KY, MO, NV, NH, NC, SC, TN, TX, UT, VA). Parallon provides full‑service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full‑service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities. HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses. “There is so much good to do in the world and so many different ways to do it.” – Dr. Thomas Frist, Sr., HCA Healthcare Co‑Founder.

Responsibilities

• Submit insurance claims to individual insurance companies electronically or via paper form
• Prepare and submit clean claims to various Medicaid agencies and/or assigned payers
• Use coded data to produce and submit claims
• Analyze remittance advice(s) to ensure accurate posting of rejections, payments and contractual adjustments timely
• Review and appeal unpaid and denied claims
• Maintain a working knowledge of payer practices and reimbursement methodologies and become a subject matter expert in assigned A/R responsibilities
• Review UB/1500 claims for accuracy and completeness and obtain missing information as needed for submission
• Identify and bill secondary or tertiary payors
• Ability to look up ICD‑10 diagnosis and CPT treatment codes from online service or using traditional coding references
• Maintain appropriate productivity requirement(s) for the role
• Review medical records related to an IP’s clinical presentations and supporting documentation to determine elevated level of care according to claim guidelines per state
• Submit electronic and paper claims according to Medicaid and department deadlines
• Collect and enter confidential information into PARALLON’s patient management system
• Collaborate with the clinical team and further clinical resources in sharpening review strategies for stronger ISD criteria documentation