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Medicaid billing specialist
Ref No.: 18-00827
Location: Framingham, Massachusetts
Start Date / End Date: 05/11/2018 to 08/31/2018

Experience: 2-5 years of experience in position or specialization. Education: High-school/Associates or equivalent experience if applicable.

Job Description

Directs telephone contacts or written inquiries to appropriate personnel. Answers non-technical questions regarding company products.
Maintains log of incoming "hotline" contacts. Performs, as a skilled worker, a number of Contact Center tasks.
Determines, based upon professional knowledge, HOW best to approach the task and how to solve abnormalities.
Analyses abnormalities that occur within own working area and reasons, based upon professional knowledge and insights, where the cause lies and remedies it.
Completes work with a limited degree of supervision.

Job Utilize monthly aging accounts receivable reports to follow up on unpaid claims aged over 30 days, filing appeals when appropriate to obtain maximum reimbursement and establish and maintain strong relationships with all stakeholders.

o Obtain authorizations for services and enter authorization, insurance, and demographics accurately and timely.
o Accurate and timely entry of CPT and diagnosis codes and the relevant authorizations to ensure clean claims are released.
o Communicate proactively of billing issues.
o Ensure all claims are submitted with a goal of zero errors.
o Verify completeness and accuracy of all claims prior to submission.
o Timely follow up on insurance claim denials, exceptions or exclusions.
o Read and interpret insurance explanation of benefits.
o Respond to inquiries from case managers, insurance companies, patients and providers and internal customers such as sales.
o Regularly attend monthly staff meetings and continuing educational sessions as requested.
o Perform additional duties and projects as requested.

o Education Requirements: High School Diploma, or equivalent. Associates Degree in Medical Billing and Coding or Accounting, preferred. Two years of experience in lieu of education may also be considered.
o Years of Experience/Training: Minimum of 2- 5 years of experience in medical billing, preferably with Medicaid and Managed Care reimbursement.
o Computer experience is essential. Must be technically savvy and comfortable using software, including, but not limited to: billing software, MS Office, Insurance Portals, and Electronic Claims Submissions. High aptitude to learn new programs, system integrations, and business processes.
o Experience in CPT and ICD-10 coding; familiarity with medical terminology.
o Excellent customer service skills.
o Strong written and verbal communication skills.
o Ability to manage relationships with various Insurance payers.
o Experience in filing claim appeals with insurance companies to ensure maximum entitled reimbursement.
o Ability to multi-task and work courteously and respectfully with fellow employees, clients and patients.
o Strong work ethic with proven track record of accuracy, dependability and consistency
o Must be able to think independently, have strong problem solving skills, and have a continuous improvement mentality.
o Team player, ability to gain the cooperation of others in pursuit of company goals.

This job operates in an office setting, sharing a large room with other employees. As a result, the work area can be crowded and/or noisy. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, fax machines, and other similar items.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential job functions of this job.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to sit, stand; walk; use hands to finger, hand or feel; and reach with hands and arms.