A/R Medicaid Specialist

• Audit, research accounts, payment posting, contractuals to confirm the accuracy of the balance of the account
• Ensure medical record requests are documented and submitted in a timely manner
• Complete tasks by deadline.
• Document all follow up efforts in a clear and concise manner into the AR system.
• Monitor and resolve claims holding on discharged not final billed (DNFB) list.
• Follow up on unpaid Medicaid and Managed Medicaid claims in a timely manner.
• Ensure all claims are filed electronically except for some paper claims.
• Attend seminars as requested.
• Identify payers being submitted on paper rather than electronically and communicate the opportunities to leadership.
• Responsible for reviewing and understanding explanation of benefits/remittance advice.
• Familiar with inpatient only procedure list and work with Revenue Cycle leadership to prevent denials
• Utilize insurance websites to view and resolve claims.
• Ensure statements are generated for the patient responsibility amounts.
• Phone contact with patient, physician office, attorney, etc for additional information to process claims.
• Work assigned accounts as directed while reaching daily productivity goals.
• Other duties as assigned.
• Perform extensive account follow-up and provide analysis of problem accounts.
• High dollar accounts will have consistent follow up until the account has been resolved.
• Identify and report all trends that may provide insight into payment challenges.

MINIMUM EDUCATION & EXPERIENCE

• Working knowledge of medical and insurance terms is desirable.
• High School Diploma, or GED
• 1 year of patient registration, billing or equivalent experience

• Ability to review, comprehend, discuss HCFA billing with Insurance or Government agencies.
• Ability to meet productivity expectations.
• Knowledge of general insurance requirements.
• Experience working directly with EOBs and contractual adjustments.
• General computer knowledge, working with electronic filing.
• Ability to communicate verbally/in writing with professionalism.