Managed Medicaid Specialist

Aperion Care; Lincolnwood (IL); On-site; USD 45,000 - 65,000; Full time

Job summary

Aperion Care seeks a Medicaid Managed Care Specialist to review and follow up on insurance claims within a Long Term Care setting. You will ensure accurate submissions, monitor processing, and manage appeals to secure payments.

The role requires experience with Medicaid billing, strong attention to detail, and the ability to communicate with payors and clients to resolve issues efficiently.

Qualifications

• Experience in Long Term Care industry preferred.
• Experience with Managed Medicaid billing required.
• Familiarity with PCC billing system preferred.

Responsibilities

• Review and process insurance claims following established procedures.
• Check accuracy of information for claim submissions.
• Monitor claim status, payments and adjustments in the billing system.
• Maintain accurate records and up-to-date billing data.
• Submit appeals and communicate with payors to obtain coverage payments.
• Follow up and allocate payments as applicable.
• Perform collections follow-up per procedures.
• Research and resolve denied claims promptly.
• Handle customer inquiries via phone, email, mail or in person.
• Assist with monthly statements and supervisor requests.
• Other duties as assigned.

Skills

Long Term Care experience

Managed Medicaid billing

Billing system knowledge

Tools

Point Click Care (PCC)

Job description

Medicaid Managed Care Specialist

The Medicaid managed Care Specialist works to review, investigate and follow-up on various insurance claims.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Ensure that established accounting procedures are followed for processing insurance claims


• Checking for accuracy of information for claim submission.


• Monitoring claims processing status, recorded payments and adjustments within the billing system.


• Maintain accurate records, up to date billing systems


• Managing and submitting appeals, calls, emails and other efforts to obtain insurance coverage payment.


• Follow-up on, collect and allocate payments as applicable


• Performing collections follow-up process in accordance with established procedures.


• Research and Resolve denied claims in a timely fashion


• Investigate and resolve customer queries and communicate with customers via phone, email, mail or personally


• Assist with preparation of monthly statements, or as requested by supervisor


• Other duties as assigned

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements below are representative of the knowledge, skill, and/or ability required.

• Experience in Long Term Care industry, preferred


• Experienced in Managed Medicaid billing


• Experience in Point Click Care (PCC) billing system is preferred

PHYSICAL DEMANDS

The physical demands 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.

• Must be able to move intermittently throughout the workday.