Medicaid Claims Management Specialist

2 weeks ago


Lincolnwood, Illinois, United States Curis Services Full time

Curis Services - Medicaid Claims Management Specialist SUMMARY: The Medicaid Claims Management Specialist is responsible for reviewing, investigating, and following up on various insurance claims to ensure proper processing and resolution.

KEY RESPONSIBILITIES:

  • Adhere to established accounting protocols for the processing of insurance claims.
  • Verify the accuracy of information submitted for claims.
  • Monitor the status of claims processing, including recorded payments and adjustments in the billing system.
  • Maintain precise records and ensure billing systems are current.
  • Manage and submit appeals, including calls and emails, to secure insurance coverage payments.
  • Conduct follow-ups on payments, ensuring proper collection and allocation as necessary.
  • Execute the collections follow-up process in line with established guidelines.
  • Research and resolve denied claims promptly.
  • Investigate and address customer inquiries, providing communication via phone, email, or in person.
  • Assist in the preparation of monthly statements or as directed by management.
  • Perform additional duties as assigned.

QUALIFICATIONS: To excel in this role, candidates must demonstrate the ability to fulfill each essential duty effectively. The following qualifications are essential:

  • Experience in the Long Term Care sector is preferred.
  • Proficiency 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 required to successfully perform the essential functions of this position. Reasonable accommodations may be made for individuals with disabilities.

  • Ability to move intermittently throughout the workday.


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