Medicaid Collector

Position Summary To succeed in this role, you must possess in-depth knowledge of Government Payor collections practices and insurance policies. The ideal candidate must also be able to demonstrate excellent written and verbal communication skills, as communicating with various insurance companies, plan administrators, team members and customers. This position requires a driven individual that can multi-task, problem solve, and manage workload and time effectively. Able to manage stress.

Job Requirements/Qualifications:

Experience with Medicaid and Manage Care Organization (MCO) Plan collections is a must. (Please specify detailed experience on resume/application for consideration) Minimum 5 years of Texas Medicaid collections or accounts receivable (AR) experience Experience with ambulance or emergency transport billing (high Medicaid volume in Texas) preferred. Strong working knowledge of Medicaid and MCO payer guidelines, fee schedules, covered services, authorization requirements, reimbursement and appeals processes. Experience handling Managed Care Organization (MCO) plans (e.g., STAR, STAR+PLUS, STAR Kids).

Experience reviewing and interpreting:

Remittance and Status (R&S) reports and Explanation of Benefits (EOBs) including MRAN Forms. Understanding of Third-Party Liability (TPL) requirements and Medicaid as payer of last resort rules. Familiarity with timely filing limits and appeal/reconsideration processes specific to Texas Medicaid. Knowledge of identifying payer denials and appeal processes. Experience with creating appeals and grievances required. Knowledge of Authorizations, Payment Posting, Reimbursement and Billing - full Revenue Cycle. Organized, dependable, self-sufficient, hardworking, analytical, and detail orientated. Strong understanding of professional claims (CMS-1500) and reimbursement methodologies. Strong phone etiquette with exceptional customer service skills. Ability to work through stressful situations professionally and respectfully. Microsoft Office 365 proficiency, specifically Excel.

Essential Job functions and responsibilities:

Experience with Medicaid and Manage Care Organization (MCO) Plan collections is a must. (Please specify detailed experience on resume/application for consideration) Minimum 5 years of Texas Medicaid collections or accounts receivable (AR) experience Experience with ambulance or emergency transport billing (high Medicaid volume in Texas) preferred. Strong working knowledge of Medicaid and MCO payer guidelines, fee schedules, covered services, authorization requirements, reimbursement and appeals processes. Experience handling Managed Care Organization (MCO) plans (e.g., STAR, STAR+PLUS, STAR Kids).

Experience reviewing and interpreting:

Remittance and Status (R&S) reports and Explanation of Benefits (EOBs) including MRAN Forms. Understanding of Third-Party Liability (TPL) requirements and Medicaid as payer of last resort rules. Familiarity with timely filing limits and appeal/reconsideration processes specific to Texas Medicaid. Knowledge of identifying payer denials and appeal processes. Experience with creating appeals and grievances required. Knowledge of Authorizations, Payment Posting, Reimbursement and Billing - full Revenue Cycle. Organized, dependable, self-sufficient, hardworking, analytical, and detail orientated. Strong understanding of professional claims (CMS-1500) and reimbursement methodologies. Strong phone etiquette with exceptional customer service skills. Ability to work through stressful situations professionally and respectfully. Microsoft Office 365 proficiency, specifically Excel.

Job Type:

Full-time Job Type:

Full-time Benefits:

401(k) matching Dental insurance Health insurance Life insurance Paid time off Vision insurance

Experience:

Medicaid Collections:

5 years (Required)

Work Location:

In person