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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 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 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, including calls and emails, to secure insurance coverage payments.
  • Conduct follow-ups on payments, collecting and allocating as necessary.
  • Execute the collections follow-up process in line 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, candidates must demonstrate the ability to perform each essential duty effectively. The following qualifications are indicative of the knowledge, skills, and abilities required:

  • 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 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 fulfill these functions.

  • Ability to move intermittently throughout the workday.