Responsibilities:

Examine service records, authorizations, care plans, and supporting documents to confirm claims are ready for submission to Minnesota Medical Assistance and other applicable payers.
Process and track claims for home care and related community-based services using payer portals, clearinghouses, and revenue cycle platforms.
Investigate unpaid, denied, rejected, underpaid, or recouped claims and take appropriate action to secure correct reimbursement.
Conduct account reviews for aged receivables, including outstanding balances over 30 days, and document follow-up activity in assigned tracking tools.
Analyze remittance information to identify payment variances, denials, adjustments, spend-down impacts, and reimbursement discrepancies.
Resolve billing exceptions by correcting claim details and submitting original, replacement, corrected, or voided claims in line with payer rules.
Review unbilled service lines regularly to ensure eligible charges are captured and submitted without unnecessary delay.
Respond to billing-related questions from internal teams and external partners, including payers, case managers, coordinators, and other stakeholders.
Maintain compliance with state and federal billing standards, documentation expectations, coding requirements, confidentiality obligations, and fraud prevention guidelines.
Escalate high-risk account concerns, authorization mismatches, documentation deficiencies, database inaccuracies, and payer-related barriers to leadership when needed.

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