Medicaid Collections Billing Specialist

HCA Healthcare; Payson (UT); Remote; USD 42,000 - 64,000; Full time

Benefits offered by this job

Comprehensive benefits

Wellbeing support

Paid time off

401(k) plan with company match

Tuition assistance

Fertility support

Life insurance

Job summary

HCA Healthcare is seeking a Medicaid Collections Billing Specialist to manage Medicaid claims in a work-from-home role, within 60 miles of an HCA hospital. This position collaborates with the Authorization Department and requires familiarity with Medicaid guidelines.

Responsibilities include submitting claims electronically or on paper, submitting clean claims to Medicaid agencies, analyzing remittance advice, appealing denials, using PARALLON system, and ensuring timely submission.

Qualifications

• High school diploma or GED required.
• Medical Billing Certification required.
• Minimum 4-5 year(s) of experience in related area required.
• Medicaid billing experience, preferred.
• 1-2 years acute medical center experience, preferred.
• Knowledge and experience of Medicaid guidelines for In-patient admissions, preferred.

Responsibilities

• Submit insurance claims to insurance companies electronically or on paper.
• Prepare and submit clean Medicaid claims to agencies.
• Use coded data to produce and submit claims.
• Analyze remittance advice to ensure accurate posting of rejections, payments and contractual adjustments timely.
• Reviews and appeals unpaid and denied claims.
• Maintain knowledge of payer practices and reimbursement methodologies.
• Review UB/1500 claims for accuracy and completeness and obtain missing information as needed.
• Identify and bill secondary or tertiary Payors.
• Look up ICD-10 diagnosis and CPT codes from online service or references.
• Maintain productivity requirements for the role.
• Review medical records to determine elevated level of care per state guidelines.
• Submit electronic and paper claims according to Medicaid deadlines.
• Enter confidential information into PARALLON’s patient management system.
• Collaborate with clinical team to sharpen review strategies for stronger ISD criteria documentation.

Education

High school diploma or GED

Medical Billing Certification

Tools

PARALLON patient management system

Job description

This Work from Home position requires that you live and will perform the duties of the position; within 60 miles of an HCA Healthcare Hospital (Our hospitals are located in the following states: FL, GA, ID, KS, KY, MO, NV, NH, NC, SC, TN, TX, UT, VA).

Experience the HCA Healthcare difference where colleagues are trusted, valued members of our healthcare team. Grow your career with an organization committed to delivering respectful, compassionate care, and where the unique and intrinsic worth of each individual is recognized.

Job Summary And Qualifications

The Medicaid Collections Billing Specialist is responsible for the review, edits, submission and collection of both electronic and paper claim submissions for state Medicaid programs and works in conjunction with the Authorization Department.

What you will do in this role:

• Submit insurance claims to individual insurance companies electronically or via paper form
• Prepare and submit clean claims to various Medicaid agencies and or assigned payers
• Use coded data to produce and submit claims
• Analyze remittance advice(s) to ensure accurate posting of rejections, payments and contractual adjustments timely.
• Reviews and appeals unpaid and denied claims
• Maintain a working knowledge of payer practices and reimbursement methodologies and become a subject matter expert in assigned A/R responsibilities.
• Review UB/1500 claims for accuracy and completeness and obtain missing information as needed for submission
• Identify and bill secondary or tertiary Payors
• Ability to look up ICD-10 diagnosis and CPT treatment codes from online service or using traditional coding references
• Maintain appropriate Productivity requirement(s) for their role
• Review medical records related to an IP’s clinical presentations and supporting documentation to determine elevated level of care according to claim guidelines per state
• Submit electronic and paper claims according to Medicaid and department deadlines
• Collect and enter confidential information into PARALLON’s patient management system
• Collaborate with the clinical team and further clinical resources in sharpening review strategies for stronger ISD criteria documentation insuring payor approvals

Qualifications

• High school diploma or GED required
• Medical Billing Certification required
• Minimum 4-5 year(s) of experience in related area required.
• Medicaid billing experience, preferred
• 1-2 years acute medical center experience, preferred
• Knowledge and experience of Medicaid guidelines for In-patient admissions, preferred

Benefits

Parallon, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

Learn More About Employee Benefits

Note: Eligibility for benefits may vary by location.

• Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services
• Wellbeing support, including free counseling and referral services
• Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence
• Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling
• Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing
• Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts

Parallon

Parallon provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities.

HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

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"There is so much good to do in the world and so many different ways to do it."- Dr. Thomas Frist, Sr.

HCA Healthcare Co-Founder

We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.