Billing Representative

American RENOLIT Corporation; Mishawaka (IN); On-site; USD 42,000 - 66,000; Full time

Job summary

American RENOLIT Corporation seeks a Medicaid Billing Specialist in Mishawaka, IN to ensure accurate and timely processing of Medicaid claims and related accounts receivable activities. You will verify eligibility, submit claims, handle denials, and support audits to maintain regulatory compliance.

Required: at least three years of Medicaid billing experience, familiarity with hospice billing preferred, and proficiency with EHR and billing software.

Qualifications

• Postsecondary coursework in Medical Billing, Coding, Health Information Management or related field.

Responsibilities

• Process Medicaid Hospice and Room & Board claims within deadlines.
• Process Medicaid authorizations with completed paperwork.
• Review claims for accuracy and Medicaid compliance before submission.
• Research and follow up on denied or unpaid Medicaid claims.
• Monitor accounts receivable and follow up on balances.
• Communicate with Medicaid representatives, MCOs, providers, and facilities.
• Assist audits and reimbursement reviews.
• Verify Medicaid eligibility and enrollment.
• Verify benefits and payer requirements for managed care plans.
• Collaborate with referral and admissions staff to determine eligibility.

Skills

Medicaid billing

Reimbursement

Documentation accuracy

Communication

Time management

Education

Postsecondary coursework in Medical Billing, Coding, Health Information Management

Job description

• Location 501 Comfort Place,Mishawaka, IN, 46545,United States
• Employee Type 5Days/8Hrs

Not a Remote position

FLSAStatus: Non- exempt

Main Purpose

ToensuretheaccurateandtimelyprocessingofMedicaidbilling, accountsreceivablemanagement, paymentposting,benefitverification,andreimbursementfollow-upactivitiesinsupportoftheAgency's financial operations and regulatorycompliance.

EssentialFunctions MedicaidClaimsProcessing

• Processes and submits Medicaid Hospice, Medicaid Room & Board, and applicable managed Medicaid claims accurately and within established billing timelines.
• Processes Medicaidauthorizations, making sure paperwork is filledoutproperlyand signed byall appropriate staff members.
• Reviewsclaimsforaccuracy, completeness, andcompliancewithstateMedicaidrequirementsprior to submission.
• Research,resolves,andfollowsupondenied,rejected,suspended,orunpaidMedicaid claims.
• Monitorsaccountsreceivable reports andperformtimelyfollow-uponoutstanding balances.
• Communicates professionally with state Medicaidrepresentatives, Managed Care Organizations (MCOs), providers, hospitals, nursing facilities, and physicianoffices regarding billing and reimbursement issues.
• Assistswithauditsandreimbursementreviewsas requested
• Verifies Medicaid eligibility, coverage periods, spend-down requirements, andmanagedcare enrollment.
• Verifies benefits and payer requirements for MedicaidManaged Care plansand secondary insurance coverage.
• Collaborateswith ReferralSpecialists, IntakeCoordinators,Admissionsstaff,andCaseManagersto ensure accurate eligibility determination.
• Identifies and resolveseligibility discrepancies prior toadmission andthroughoutthepatient's episode of care.
• Documentsverificationdetailsaccuratelywithindesignatedsoftwareandrelated systems.
• Communicates coverage information and authorization requirements to appropriate staff members.

Medicaid Notifications and Authorizations

• ReviewsandmonitorsMedicaidnotifications,approvals,denials,andeligibility determinationnotices.
• Tracks required authorization, level-of-care determinations, and Medicaid approval documentation.
• ScansandfilesMedicaidnotificationlettersandsupportingdocumentationintothe electronic medical record.
• WorkswithAdmissions,ClinicalStaff,andStateAgenciestoobtain required documentationfor reimbursement.

AccountsReceivable Management

• Performs follow-up on unpaid or underpaid Medicaid claims.
• Communicates reimbursement concerns and recommendations to management.
• Collaborates with Clinical and Finance staff to resolve documentation deficiencies impactingpayment.

Administrative Duties

• SupportstheAgency's commitmenttopreventing fraud,waste,and abuse.
• Maintainsknowledgeofhospicephilosophyandapplicablefederal,state,andpayer regulations.
• Arrivalsatworkandmeetingspreparedandon time.
• Attends required educational programs and continuing education opportunities.
• Demonstratesflexibilityandadaptabilityinresponsetochangingorganizationalneedsandregulatoryrequirements.
• Promotespositiveworkingrelationshipswithpatients,families,referralsources,and colleagues.
• Performs otherrelateddutiesas assigned.

Compliance and Confidentiality

• Adheres toall Medicaid, Medicaid,HIPAA, andotherapplicablefederaland state regulations.
• Maintains confidentiality and safeguards protected health information.
• F ollows Agency policies, compliance with standards, and reporting requirements
• Participatesincomplianceeducationandbillingauditsasrequired

Physicaland Mental Requirements

Theemployeemustbeable to:

• Communicate effectively in English through verbal and written communication.
• Hearandunderstandnormalconversationsinpersonandby telephone.
• Seewithsufficientvisualacuitytoreviewrecords,computerscreens,and documentation.
• Usehands,wrists,andfingerscontinuouslyfortyping,writing,dataentry,and operationof officeequipment.
• Sit for extended periods while performing computer-based work.

Qualifications Education

• Postsecondary courseworkin Medical Billing, Coding, Health Information Management, or related field preferred.

Experience

• Minimumofthree(3)yearsofexperienceworkingwithMedicaidbillingand reimbursement.
• Knowledgeof 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.
• Experiencewithclaimsfollow-up,denialmanagement,andaccountsreceivableprocesses preferred.

Knowledge, Skills, and Abilities

• StrongunderstandingofMedicaidregulationsclaimsprocessing,andreimbursement 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.
• Excellent verbal and written communication skills.
• Ability to maintain confidentiality and professionalism.
• Abilitytoworkindependentlyandcollaborativelywithinateam environment.