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Medicaid Claims Management Specialist

2 months ago

Lincolnwood, Illinois, United States Curis Services Full time

Curis Services - Medicaid Claims Management Specialist SUMMARY:The Medicaid Claims Management Specialist is responsible for the thorough review, investigation, and follow-up of various insurance claims.

KEY RESPONSIBILITIES:

  • Adhere to established accounting protocols for the processing of insurance claims.
  • Verify the accuracy of information prior to claim submission.
  • Monitor the status of claims processing, including recorded payments and adjustments within the billing system.
  • Maintain precise records and ensure billing systems are current.
  • Manage and submit appeals, as well as engage in calls and emails to secure insurance coverage payments.
  • Conduct follow-ups, collect, and allocate payments as necessary.
  • Execute the collections follow-up process in accordance with established guidelines.
  • Research and resolve denied claims promptly.
  • Investigate and address customer inquiries, communicating through various channels.
  • Assist in the preparation of monthly statements or as directed by management.
  • Perform additional duties as assigned.

QUALIFICATIONS: To excel in this role, an individual must effectively perform each essential duty. The following qualifications are representative of the knowledge, skills, and abilities required:

  • Experience in the Long Term Care sector is preferred.
  • Proficient in Managed Medicaid billing practices.
  • Familiarity with the Point Click Care (PCC) billing system is advantageous.

PHYSICAL REQUIREMENTS: The physical demands outlined are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform these functions.

  • Ability to move intermittently throughout the workday.