Position Summary
Primarily responsible for thorough review of Medicaid managed care contracts and comparison of such contracts against Medicaid claims to identify underpayments for the assigned client.
Duties and Responsibilities
- Build strong, lasting relationships with clients, payors and BLS personnel
- Review insurance contracts to gain thorough understanding of payment methodologies
- Examine claims and calculate reimbursement based on contract terms to determine accuracy of payment through use of various reports and supporting documentation
- Contact insurance company to obtain missing information, explain and resolve underpayments and arrange for payment or adjustment processing on behalf of client
- Prepare and submit correspondence such as letters, emails, online inquiries, appeals, adjustments, reports and payment posting
- Maintain regular contact with necessary parties regarding claims status including payors, clients, managers, and other BLS personnel
- Direct claims to and coordinate and support BLS specialty units
- Attend client, department and company meetings
- Comply with federal and state laws, company policies and procedures
Skills and Experience
- Minimum 3-years Medicaid experience working with claims and/or billing
- Accounts receivable/follow-up experience
- Moderate computer proficiency including working knowledge of Microsoft Word and Excel
- High school diploma or equivalent
- Mathematical skills: ability to calculate rates using addition, subtraction, multiplication and division
- Ability to read and interpret an extensive variety of documents such as contracts, claims, instructions, policies and procedures in written (in English) and diagram form
- Ability to write routine correspondence (in English)
- Ability to define problems, collect data, establish facts and draw valid conclusions
- Strong customer service orientation
- Excellent interpersonal and communication skills
- Strong team player
- Commitment to company values
- Associate or Bachelors Degree preferred but not required
Disclaimer: BLS salaries are intentionally not posted and are based on level of experience. Some sites arbitrarily post salaries but are not an accurate representation.
Candidates must be currently and in the future authorized to work in the United States on a full-time basis. BLS does not sponsor candidates for permanent residency.