What are the responsibilities and job description for the MEDICAID SPECIALIST - MICHIGAN position at Medstar Ambulance?
The Medicaid Specialist is a remote position in Michigan only. The position is responsible for managing and processing all Medicare claim denials in compliance with state and federal guidelines of Michigan. The Medicaid specialist works closely with department management to maintain efficient billing and reimbursement of all Medicare claims. Position will also be responsible for reporting denials trends on a monthly basis and identifying individuals in the department responsible for denials. This position will be responsible for staying up to date with Medicaid updates, available Medicaid training and communicate this training with department manager. Responsible for accurate sending and receiving of claim submissions. Work with cash posting to work and resolve any zero payments within 24 hours of the posted payments. Position will follow up all Medicaid A/R on outstanding claims, oversee the Medicaid aging and denial workflows to ensure timely claim processing and follow-up. Analyze and resolve issues with Medicaid payors and report findings and solutions to billing manager in a timely manner.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Perform monthly report of all Medicaid denials and discuss findings with Billing Management and VP of Healthcare Integration.
- Monitor changes in Medicaid regulations and report changes and updates to department manager.
- Ensure compliance with Medicaid with billing and coding compliance.
- Investigate and resolve any Medicaid denials or billing discrepancies.
- Review and work all Medicaid refunds sent to you by obtaining appropriate documentation, then determining the correct means of issuing the refund, either electronically or by creating a check request prior to sending to accounts payable.
- Meet with department management bi-monthly to review current Medicaid aging and review current Medicaid A/R.
- Other duties as assigned.
Education and Training Requirements:
- High School diploma required; some college preferred
- 5 years of ambulance billing
- Strong computer skills
- Strong verbal and written communication and customer service skills
- Strong attention to detail and accuracy in data entry
- Ability to decipher information from the CMS coding guidelines and apply the accurate information to patient information
- Trauma Soft Experience Preferred.
