Medicaid Claims Specialist in Patient Services

2 weeks ago


Fort Lauderdale, Florida, United States Catholic Health Services Full time

Overview

The role involves managing the billing processes and ensuring timely follow-up for all assigned Medicaid claims related to nursing facilities and hospitals, while maintaining cost-effectiveness and efficiency. Effective management of accounts receivable is achieved through collaboration with nursing home and hospital administrative teams, as well as various governmental regulatory bodies.

Key Responsibilities

  • Conduct monthly billing for Medicare inpatient and outpatient claims associated with nursing homes and rehabilitation hospitals.
  • Perform reconciliation of monthly Medicare bills against billing recaps generated from the KEANE software.
  • Generate and analyze accounts receivable aging reports post month-end close to facilitate follow-up actions.
  • Oversee annual billing for vaccinations across all facilities.
  • Provide daily updates on expected cash receipts from Medicare, ensuring accurate comparisons with monthly billing recaps.
  • Review aged trial balances to identify claims exceeding 90 days and ensure timely resolution.
  • Analyze Return to Provider claims to identify errors and implement preventive measures.
  • Examine recurring billing trends to modify Medicare specifications and reduce redundancy in corrections.
  • Engage in cross-training within the Central Billing Office to enhance departmental knowledge and teamwork.
  • Audit accounts with Medicare denials to resolve outstanding balances.
  • Accurately input information for claims corrections regarding CPT and ICD-10 codes, ensuring timely submissions to Medicare.
  • Follow up on all outstanding claims older than 30 days, ensuring effective resolution.
  • Maintain strong working relationships with counterparts in various departments to support effective revenue cycle management.
  • Utilize departmental tools and systems to identify and communicate issues that may lead to payment delays or revenue loss.
  • Manage ISNP billing and follow-up by generating reports for various charges.
  • Handle monthly billing and follow-up for all Hospice claims.

Additional Responsibilities

  • Perform other duties as assigned by the Revenue Cycle Manager.
  • Maintain required licenses, certifications, and skill updates.
  • Adhere to all relevant policies and regulations.
  • Complete additional tasks as needed.

Supervisory Role

  • This position does not have direct supervisory responsibilities.

Disclaimer

This job description is intended to provide a general overview of the position and is not exhaustive of all duties and responsibilities that may be assigned.

EEOC Statement

Catholic Health Services is committed to providing equal employment opportunities and prohibits discrimination and harassment of any kind.

Qualifications

  • High school diploma with two years of relevant experience or a combination of education and training.
  • Proficient in using computers, calculators, and office software.
  • Familiarity with clinical software and the ability to interpret Medicare benefits.
  • Knowledge of Medicare eligibility and entitlement details.

Physical Requirements

  • Ability to lift and move items up to 25 pounds, with occasional lifting of up to 50 pounds.
  • Work in an office environment with moderate to loud noise levels.
  • Subject to frequent interruptions and may require working beyond typical hours.
  • Hand dexterity for data entry tasks is essential.


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