Medicaid Revenue & Claims Specialist

EnableComp LLC; Franklin (TN); Hybrid; USD 42,000 - 56,000; Full time

Job summary

EnableComp LLC in Franklin, TN is hiring a Revenue Specialist, Medicaid. You will ensure proper submission and adjudication of Medicaid claims while maintaining PHI privacy and meeting deadlines.

Key duties include eligibility verification, analyzing payments, gathering records, submitting initial bill packets, and following up with payers to secure prompt reimbursement. Prior experience with UB-04 is preferred.

Qualifications

• 1-2+ years’ experience in healthcare field working in billing or collections.
• 1+ years’ client facing/customer services experience.
• 1+ years’ experience with UB-04 billing and collections required.
• CMS-1500 billing and other complex claims experience a plus.
• Intermediate level understanding of insurance payer/provider claims processing.

Responsibilities

• Verify patient eligibility when needed.
• Analyze and evaluate Medicaid claim payments using the company’s systems and tools.
• Research, request and acquire all pertinent medical records and submit with hospital claims for prompt reimbursement.
• Review UB 04 components for accuracy and adjust as required by billing laws.
• Conduct timely telephone follow-up with payers to ensure timely reimbursement.
• Prepare correct Medicaid initial bill packet using EnableComp systems’ tools and submit with supporting documentation.
• Analyze assigned account delinquencies to ensure timely payments from payers.
• Work with insurers to verify authorizations and assist in concurrent review activities.
• Handle PHI and adhere to HIPAA guidelines.
• Manage inbound and outbound calls effectively; contribute to team goals.
• Appeal denials and underpayments as necessary.

Skills

Customer service

Attention to detail

Communication skills

Time management

Education

High School Diploma or GED required

Associates or Bachelor's Degree preferred

Tools

UB-04 billing software

MS Office

Job description

EnableComp LLC in Franklin, TN is hiring a Revenue Specialist, Medicaid. You will ensure proper submission and adjudication of Medicaid claims while maintaining PHI privacy and meeting deadlines.

Key duties include eligibility verification, analyzing payments, gathering records, submitting initial bill packets, and following up with payers to secure prompt reimbursement. Prior experience with UB-04 is preferred.