Primary Location:

250 E Liberty St

Address:

250 East Liberty St. Louisville, KY 40202

Shift:

First Shift (United States of America)

Job Description Summary:

Job Description:

This position requires thorough knowledge of the Uniform Bill, Medicaid, Medicare and Medicare Advantage billing, secondary deductible/coinsurance billing, and the Direct Data Entry (DDE) system for follow up. The specialist performs all duties related to timely and efficient billing and follow-up using their thorough understanding of Medicaid eligibility, benefits, determining primary payer, and covered benefits.

Additional Job Description:

Essential Functions

• Monitor and resolve claims holding on discharged not final billed (DNFB) list.
• Assure all claims are filed electronically except for some paper claims.
• Process claims identified from insurance discovery.
• Submit account for appeal on accounts where retroactive coverage has been obtained.
• Identify payers being submitted on paper rather than electronically and communicate the opportunities to leadership.
• Follow up on unpaid Medicaid and Managed Medicaid claims in a timely manner.
• High dollar accounts will have consistent follow up until the account has been resolved.
• Responsible for reviewing and understanding explanation of benefits/remittance advice.
• Assure statements are generated for the patient responsibility amounts.
• Utilize insurance websites to view and resolve claims.
• Perform extensive account follow-up and provide analysis of problem accounts.
• Document all follow up efforts in a clear and concise manner into the AR system.
• Compliance with State and Federal Regulations.
• Audit, research accounts, payment posting, contractuals to confirm the accuracy of the balance of the account.
• Assure medical record requests are documented and submitted in a timely manner.
• Collaborate with denials team on difficult or reoccurring denials.
• Complete tasks by deadline.
• Identify and report all trends that may provide insight into payment challenges.
• Phone contact with patient, physician office, attorney, etc. for additional information to process the claim.
• Work assigned accounts as directed while reaching daily productivity goals.
• Attend seminars as requested.
• Other duties as assigned.

Skills, Knowledge or Abilities critical to this role:

• Working knowledge of medical and insurance terms.
• Ability to review, comprehend, discuss HCFA billing with Insurance or Government agencies.
• Knowledge of general insurance requirements. 
• Experience working directly with EOBs and contractual adjustments.