SUMMARY:

This position supports the functions for cooperation with various third-party payers, especially the acquisition of prior authorizations. Tasks include the application of record keeping principles and practices, maximizing allowable service revenue, performing data entry, communicating with third-party payers, and monitoring, recording, or reviewing documents and clinical information.

QUALIFICATIONS/DEGREE

High school diploma or GED required. Must possess a working knowledge in the operation of office equipment, especially computers. Medicaid billing experience required. Must have good verbal communication skills, congenial manner, and professional commitment to confidential record keeping.

COMPETENCIES

1.

ABLE TO RECOGNIZE NON-VERBAL COMMUNICATIONS 2. CAN ASCERTAIN AND CONVEY CUSTOMER EXPECTATIONS 3. CAN IDENTIFY CONFIDENTIAL INFORMATION 4. ABLE TO DISTINGUISH COURTESY FROM DISCOURTESY 5. CAN ORGANIZE AND CONSOLIDATE INFORMATION AND DATA RESPONSIBILITIES

1. Prepares Medicaid and MRO charges for billing by ensuring the charge has correct "bill-to" clearinghouse. 2. Bills Medicaid and MRO charges by creating an electronic file to upload to the clearinghouse. 3. Manual bill secondary claims. 4. Bills special accounts to Medicaid and know the software that is used to bill if different from CareLogic. 5. Post payments for Medicaid and MRO from deposit. 6. Post payments for special accounts for Medicaid. 7. Works denials for all claims as well as requesting more units from Medicaid. 8. Follow up on changes of insurance. 9. Verify Benefits. 10. Process Prior Authorization's for Medicaid. 11. Appeals to the insurance if needed.

QUALIFICATION REQUIREMENTS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed in the description are representative of knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

LANGUAGE SKILLS

Ability to read, analyze, and interpret human service periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, clinical records, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients and the general public.

MATHEMATICAL SKILLS

Ability to calculate figures and amounts such as percentage, mean, mode and median. Ability to draw and interpret bar graphs.

REASONING ABILITY

Ability to define problems, collect data, establish facts, and draw valid conclusions.

PHYSCIAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, type on a computer keyboard, use hand to finger, handle or fell objects, tools, or controls, and reach with hands and arms. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

OSHA CATEGORY

This position performs tasks that involve no exposure to blood, body fluids, or tissues, but employment may require responding to unplanned health emergencies.

Job Type:

Full-time Pay:

$16.39 - $23.13 per hour

Benefits:

Dental insurance Employee assistance program Flexible schedule Health insurance Life insurance Paid time off Retirement plan Tuition reimbursement Vision insurance

Work Location:

In person