Medicaid Collections Billing Specialist

About the role

This Work from Home position requires that you live and will perform the duties of the position within 60 miles of an HCA Healthcare Hospital (Our hospitals are located in the following states: FL, GA, ID, KS, KY, MO, NV, NH, NC, SC, TN, TX, UT, VA). Experience the HCA Healthcare difference where colleagues are trusted, valued members of our healthcare team. Grow your career with an organization committed to delivering respectful, compassionate care, and where the unique and intrinsic worth of each individual is recognized.

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
• Reviews and appeals 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 their 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 insuring payor approvals

Qualifications

• High school diploma or GED required
• Medical Billing Certification required
• Minimum 4-5 year(s) of experience in related area required
• Medicaid billing experience, preferred
• 1-2 years acute medical center experience, preferred
• Knowledge and experience of Medicaid guidelines for In-p