Medicaid Specialist, 250 E. Liberty, 8:00a-4:30p

UofL Health•Louisville, KY

7d•Onsite

About The Position

About UofL Health: UofL Health is a fully integrated regional academic health system with five hospitals, four medical centers, nearly 200 physician practice locations, more than 700 providers, the Frazier Rehab Institute and Brown Cancer Center. With more than 12,000 team members—physicians, surgeons, nurses, pharmacists and other highly skilled health care professionals—UofL Health is focused on one mission: delivering patient-centered care to each and every patient each and every day. Position Summary and Purpose This position requires thorough knowledge of the Uniform Bill, Medicaid, Medicare and Medicare Advantage billing, secondary deductible/coinsurance billing, and the Direct Data Entry (DDE) system for follow up. The specialist performs all duties related to timely and efficient billing and follow-up using their thorough understanding of Medicaid eligibility, benefits, determining primary payer, and covered benefits.

Requirements

Thorough knowledge of the Uniform Bill, Medicaid, Medicare and Medicare Advantage billing, secondary deductible/coinsurance billing, and the Direct Data Entry (DDE) system for follow up.
Thorough understanding of Medicaid eligibility, benefits, determining primary payer, and covered benefits.
High School Diploma or GED/Equivalent (required)
One (1) year of patient registration, billing or equivalent experience (required)
Ability to review, comprehend, discuss HCFA billing with Insurance or Government agencies
Knowledge of general insurance requirements
Experience working directly with EOBs and contractual adjustments
General computer knowledge, working with electronic filing
Ability to communicate verbally/in writing with professionalism
Ability to meet productivity expectations
Must be able to communicate effectively in both verbal and written formats
Ability to break down problems or tasks; using prior knowledge and experience to identify causes and consequences of events
General computer knowledge
Must have the ability to learn and use relevant systems appropriately

Nice To Haves

Working knowledge of medical and insurance terms (preferred)

Responsibilities

Monitors and resolves claims holding on discharged not final billed (DNFB) list
Ensures claims are filed electronically except for specified paper claims
Identifies payers being submitted on paper rather than electronically and communicate the opportunities to leadership
Follows up on unpaid Medicaid claims in a timely manner
Ensures high-dollar accounts have consistent follow up until the account has been resolved
Responsible for reviewing and understanding explanation of benefits/remittance advice
Ensures statements are generated for the patient responsibility amounts
Utilizes insurance websites to view and resolve claims
Performs extensive account follow-up and provide analysis of problem accounts
Documents all follow up efforts in a clear and concise manner into the AR system
Submits shadow claims for inpatient payers
Audits and researches accounts, payment postings and contractual to confirm the accuracy of the balance of the account
Adheres to CMS guidelines for coordination of payment/coverage with all other appropriate payers
Ensures medical record requests are documented and submitted in a timely manner
Phone contacts with patient, physician office, attorney, etc. for additional information to process claims
Maintains familiarity with inpatient-only procedure list and works with Revenue Cycle leadership to prevent denials
Identifies and reports all trends that may provide insight into payment challenges
Works on assigned accounts as directed while reaching daily productivity goals
Completes tasks by deadline
Attends seminars as requested
Maintains compliance with all company policies, procedures and standards of conduct
Complies with HIPAA privacy and security requirements to maintain confidentiality at all times
Performs other duties as assigned
Demonstrates a commitment to service, organization values and professionalism through appropriate conduct and demeanor at all times
Maintains confidentiality and protects sensitive data at all times
Adheres to organizational and department specific safety standards and guidelines
Works collaboratively and supports efforts of team members
Demonstrates exceptional customer service and interacts effectively with physicians, patients, residents, visitors, staff and the broader health care community
Honoring and caring for the dignity of all persons in mind, body, and spirit
Ensuring the highest quality of care for those we serve
Working together as a team to achieve our goals
Improving continuously by listening, and asking for and responding to feedback
Seeking new and better ways to meet the needs of those we serve
Using our resources wisely
Understanding how each of our roles contributes to the success of UofL Health