Medicaid Billing Specialist

Under the direction of the Director of Revenue Cycle or designee, the Medicaid Billing Specialist ensures all traditional Medicaid and Medicaid Managed Care claims are reviewed for claim edits, claim submission, and timely follow up.

Responsibilities:

• Validate and make corrections on the UB04 resolving all claim edits before claim submission.
• Review claims before submission for missing modifiers, charges, and/or implants.
• Validate pharmacy quantities are reflected on the claim correctly.
• Validate claim against the coding abstract to ensure accurate billing of procedures.
• Review 24 and 72-hour admission report combining claims, as needed.
• Split inpatient claims as appropriate, per carrier guidelines.
• Submit claims to carriers with the appropriate remarks and/or attachments.
• Run insurance eligibility as needed.
• Other billing assignments, within skillsets and abilities.

Requirements:

• High School Diploma or equivalent. Associates Degree or some college is preferred.
• Minimum 2-years Medicaid billing experience in an acute care facility.
• Working knowledge of Common Procedural Terminology (CPT) and ICD10 Codes.
• Working knowledge of Federal, State, Commercial, and County billing guidelines.