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Medicaid Care Management Specialist

2 months ago

Lincolnwood, Illinois, United States Curis Services Full time

Curis Services - Medicaid Care Management Specialist Overview: The Medicaid Care Management Specialist is responsible for evaluating, investigating, and following up on a variety of insurance claims.

KEY RESPONSIBILITIES:

  • Ensure compliance with established accounting protocols for processing 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, emails, and other communications to secure insurance coverage payments.
  • Conduct follow-ups on, collect, and allocate payments 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 via phone, email, mail, or in person.
  • Assist in the preparation of monthly statements or as directed by management.
  • Perform additional duties as assigned.

REQUIREMENTS: To excel in this role, candidates must demonstrate the ability to fulfill 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.
  • 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 execute 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.