POSITION SUMMARY:
This role is responsible to ensure out of state Medicaid enrollment documents are complete and submitted to ensure reimbursement for our hospitals and to maintain the re-enrollment cadence, when appropriate. In addition, this position is the subject matter expert on each state’s enrollment and billing requirements and performs analysis of the state’s provider manuals to ensure accurate and timely creation of claims within the revenue cycle billing platforms to ensure timely and accurate electronic billing. Works closely with other revenue cycle work stream leaders and will provide assistance and education to the collection and denial team members to recover reimbursement in a timely manner. This position will facilitate all responsibilities related to out of state Medicaid enrollment, billing and education and ensure that all patient/customer interactions meet LCMC’s goals vision and standards.
This job description is intended to describe the general nature and level of the work being performed by people assigned to this work. This is not an exhaustive list of all duties and responsibilities. LCMC Health reserves the right to amend and change responsibilities to meet organizational needs as necessary.
JOB SPECIFICATIONS:
Education:
Minimum Required: High School Diploma
Preferred: Undergraduate Degree
Experience:
Minimum Required: Two years of Revenue Cycle operations experience to include billing or collections.
Preferred: Specialized focus on Medicaid or Managed Medicaid third party payer billing and/or collection interactions. Prior experience with submission of provider enrollment applications is a plus.
Special Skills/Training:
Minimum Required: Excellent problem-solving skills, ability to create and maintain Excel spreadsheets, knowledge of billing and collection procedures.
Preferred: Medicaid credentialing, billing and/or collection experience preferred. Previous interaction via payer meetings experience highly desirable. Ability to research and formulate plan to ensure provider enrollment and work closely with IT and Billing leaders to devise claim form requirement to ensure reimbursement electronically and assist cash posting team with 837/835 electronic files.
POSITION DUTIES:
Out of State Medicaid Expertise
- Develop comprehensive knowledge of OOS Medicaid program application process based on individual state requirements and coordinate inventory and timeline for enrollment applications and billing templates.
Out of State Medicaid Credentialing Process
- Maintain each entity’s credentialing documents necessary to apply for a participating provider number.
Organization and Development Skills
- Devise certification cadence to ensure provider numbers remain active.
Facilitate Epic Build & Maintance
- Maintain expertise related to billing and collection for each OOS Medicaid plan and facilitate the claim billed in EPIC to ensure LCMC claims submission meets the OOS Medicaid requirements.
Out of State Medicaid Billing & Collection of AR
- Responsible for OOS Medicaid collection of A/R and the accurate creation of Epic payer plans and billing templates to allow for accurate electronic billing and facilitation of electronic remittance processes.
LCMC Health is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability status, protected veteran status or any other characteristic protected by law.