Billing Representative

Center4Hospice; Mishawaka (IN); Presencial; USD 52.000 - 70.000; Jornada completa

Descripción de la vacante

Center4Hospice in Mishawaka, IN seeks a Medicaid Billing Rep/Billing Coordinator to ensure accurate Medicaid billing, AR management, payment posting, eligibility verification, and reimbursement follow-up in support of financial operations and regulatory compliance.

The role requires processing Medicaid claims, authorizations, eligibility verification, and ongoing follow-up on denied or unpaid claims, while maintaining detailed records and communicating with state agencies and providers.

Formación

• Requires understanding of Medicaid billing and reimbursement.
• Experience with claims follow-up and denial management preferred.
• Knowledge of hospice billing practices is a plus.

Responsabilidades

• Process Medicaid Hospice and Room & Board claims accurately and timely.
• Verify eligibility and benefits for Medicaid Managed Care plans.
• Post Medicaid payments and adjustments accurately.
• Research and follow up on denied or unpaid claims.
• Maintain documentation to support reimbursement and compliance.

Conocimientos

Medicaid billing

Claims processing

Eligibility verification

Accounts receivable

Communication

Documentation

Educación

High School Diploma or equivalent

Postsecondary coursework in Medical Billing or Health Information Management

Herramientas

Billing software

EHR systems

Microsoft Office

Descripción del empleo

Medicaid Billing Rep Billing Coordinator Full-time M-F

Not a Remote position

Brief Description

FLSA Status: Non-exempt

Main Purpose

To ensure the accurate and timely processing of Medicaid billing, accounts receivable management, payment posting, benefit verification, and reimbursement follow-up activities in support of the Agency's financial operations and regulatory compliance.

Essential Functions Medicaid Claims Processing

• Processes and submits Medicaid Hospice, Medicaid Room & Board, and applicable managed Medicaid claims accurately and within established billing timelines.
• Processes Medicaid authorizations, making sure paperwork is filled out properly and signed by all appropriate staff members.
• Reviews claims for accuracy, completeness, and compliance with state Medicaid requirements prior to submission.
• Posts Medicaid payments and adjustments accurately and timely.
• Research, resolves, and follows up on denied, rejected, suspended, or unpaid Medicaid claims.
• Monitors accounts receivable reports and perform timely follow-up on outstanding balances.
• Maintains documentation necessary to support Medicaid eligibility and reimbursement.
• Communicates professionally with state Medicaid representatives, Managed Care Organizations (MCOs), providers, hospitals, nursing facilities, and physician offices regarding billing and reimbursement issues.
• Maintains detailed records of claim status, billing activity, and collection efforts.
• Assists with audits and reimbursement reviews as requested.

Medicaid Eligibility and Benefits Verification

• Verifies Medicaid eligibility, coverage periods, spend-down requirements, and managed care enrollment.
• Verifies benefits and payer requirements for Medicaid Managed Care plans and secondary insurance coverage.
• Collaborates with Referral Specialists, Intake Coordinators, Admissions staff, and Case Managers to ensure accurate eligibility determination.
• Identifies and resolves eligibility discrepancies prior to admission and throughout the patient's episode of care.
• Documents verification details accurately within designated software and related systems.
• Communicates coverage information and authorization requirements to appropriate staff members.
• Monitors Medicaid approval, pending, and redetermination statuses as applicable.

Medicaid Notifications and Authorizations

• Reviews and monitors Medicaid notifications, approvals, denials, and eligibility determination notices.
• Tracks required authorization, level-of-care determinations, and Medicaid approval documentation.
• Scans and files Medicaid notification letters and supporting documentation into the electronic medical record.
• Works with Admissions, Clinical Staff, and State Agencies to obtain required documentation for reimbursement.
• Maintains records of Medicaid approvals, discharge notifications, and regulatory reporting requirements.

Accounts Receivable Management

• Performs follow-up on unpaid or underpaid Medicaid claims.
• Maintains claim appeals and supporting documentation for denied claims.
• Identifies billing trends, reimbursement issues, and recurring claim errors.
• Communicates reimbursement concerns and recommendations to management.
• Collaborates with Clinical and Finance staff to resolve documentation deficiencies impacting payment.

Administrative Duties

• Supports the Agency's commitment to preventing fraud, waste, and abuse.
• Maintains knowledge of hospice philosophy and applicable federal, state, and payer regulations.
• Maintains Medicaid tracking and reimbursements.
• Arrivals at work and meetings prepared and on time.
• Attends required educational programs and continuing education opportunities.
• Demonstrates flexibility and adaptability in response to changing organizational needs and regulatory requirements.
• Works effectively under time constraints while maintaining quality and accuracy standards.
• Promotes positive working relationships with patients, families, referral sources, and colleagues.
• Supports the Agency's mission, vision, values, and culture.
• Performs other related duties as assigned.

Compliance and Confidentiality

• Adheres to all Medicaid, Medicaid, HIPAA, and other applicable federal and state regulations.
• Maintains confidentiality and safeguards protected health information.
• Follows Agency policies, compliance with standards, and reporting requirements.
• Participates in compliance education and billing audits as required.

Physical and Mental Requirements

• Communicate effectively in English through verbal and written communication.
• Hear and understand normal conversations in person and by telephone.
• See with sufficient visual acuity to review records, computer screens, and documentation.
• Use hands, wrists, and fingers continuously for typing, writing, data entry, and operation of office equipment.
• Sit for extended periods while performing computer-based work.
• Maintain concentration, accuracy, and attention to detail in a fast-paced environment.
• Manage multiple priorities and deadlines effectively.

Qualifications Education

• High School Diploma or equivalent required.
• Postsecondary coursework in Medical Billing, Coding, Health Information Management, or related field preferred.

Experience

• Minimum of three (3) years of experience working with Medicaid billing and reimbursement.
• Knowledge of hospice billing practices is strongly preferred.
• Experience with Medicaid and commercial insurance billing is preferred.
• Experience working with electronic health records and billing software required.

Experience with claims follow-up, denial management, and accounts receivable processes preferred.

Knowledge, Skills, And Abilities

• Strong understanding of Medicaid regulations claims processing, and reimbursement guidelines.
• Strong computer skills, including proficiency with Microsoft Office applications and billing systems.
• Excellent organizational and time management skills.
• Ability to prioritize workload and meet deadlines.
• Strong analytical and problem-solving abilities.
• Excellent verbal and written communication skills.
• Ability to maintain confidentiality and professionalism.
• Ability to work independently and collaboratively within a team environment.
• Strong attention to detail and commitment to accuracy