Medicaid Billing Specialist

Oklahoma Arthritis Center (OAC) is an Equal Employment Opportunity employer and considers all applicants without regard to race, religion, color, sex, national origin, age, disability, veteran status, or any other legally protected status.

Job Summary

Responsible for resolving Medicaid denied claims and entering Medicaid secondary claims on to the Oklahoma Health Care Authority (OHCA) porta.

Essential Functions

• Recognize and track Medicaid denial trends.
• Research how to resolve Medicaid denial issues.
• Enter claims onto the Medicaid portal.
• Identify delinquent accounts, aging period and payment sources.
• Review accounts for possible assignment to collection agency or other account determination.
• Responds to patient/payer inquiries in a timely manner.
• Follows up on unpaid or improperly paid claims as necessary.
• Reviews and monitors select accounts within the accounts receivable.
• Ensure patient confidentiality and follow HIPAA guidelines.
• Promote a professional image by adhering to the established dress code as listed in Employee Handbook.
• Check and resolve assigned tasks in EHR program.
• Other duties as assigned by Administration.
• Assist co-workers as needed.
• Recognize when others are in need of assistance, information or directions and offers to help when able, or find someone who can.
• Responsible for neatness of work area to include stocking and cleaning. Be productive when faced with any “down time” during work hours.
• Maintain emotional control and diplomacy at all times.
• Maintain open and positive lines of communication.
• Consistently report to work on time, begins work promptly and perform duties for entire scheduled shift.
• Maintain absenteeism within company policy.
• Notify Administration of absences and tardiness in a timely manner.
• Read new policies and documents as instructed.
• Adhere to company policies and procedures.
• Demonstrate sensible and efficient use of equipment and supplies by limiting waste, spoilage or damage.

Performance Requirements:

Knowledge

• Knowledge of medical billing and collection practices.
• Knowledge of basic medical coding.
• Knowledge of third-party payer operating procedures and practices.
• Knowledge of Medicare requirements.

Skills

• Proficient skills in computer programs.
• Skill in trouble-shooting insurance claims and problems.
• Skill in establishing and maintaining effective internal and external working relationships.

Abilities

• Ability to accurately enter data and examine insurance documents.
• Ability to deal courteously with patients, staff and others.
• Ability to communicate effectively and clearly.

Qualifications

• A High School Diploma or GED required.
• A combination of six to twelve months of directly related training and/or billing experience in a health care organization is typically required for carrying out the responsibilities for this job.

Physical Requirements

• Ability to work effectively in a fast-paced environment.
• Physical ability to sit, perform data entry and view computer screen for long periods at a time.
• Occasional exposure to communicable diseases and biohazards.
• Daily standing, walking, bending, and maneuvering.
• May require lifting up to 50 pounds or more to transfer and/or turn patient with and without assistive devices.

Travel:

Travel may be required.

Scheduled Working Hours:

Normal work hours are 8:00 a.m. to 5:00 p.m., Monday through Thursday and 8:00 a.m. to 1:00 p.m. on Fridays. Hours may vary depending upon the needs of the position, department, and clinic.

Other Duties:

Please note this job description is not designed to cover or to contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change from time to time, with or without notice.

Equipment Operated:

Standard office equipment including: computers, printers, faxes, copiers, postage machine, etc.