Billing Representative

Brief Description Medicaid Billing Rep Billing Coordinator Full-time M-F FLSA Status: Non-exempt

Main Purpose

To ensure the accurate and timely processing of Medicaid billing, accounts receivable management, payment posting, benefit verification, and reimbursement follow-up activities in support of the Agency's financial operations and regulatory compliance.

Essential Functions Medicaid Claims Processing

• Processes and submits Medicaid Hospice, Medicaid Room & Board, and applicable managed Medicaid claims accurately and within established billing timelines.
• Processes Medicaid authorizations, making sure paperwork is filled out properly and signed by all appropriate staff members.
• Reviews claims for accuracy, completeness, and compliance with state Medicaid requirements prior to submission.
• Posts Medicaid payments and adjustments accurately and timely.
• Research, resolves, and follows up on denied, rejected, suspended, or unpaid Medicaid claims.
• Monitors accounts receivable reports and perform timely follow-up on outstanding balances.
• Maintains documentation necessary to support Medicaid eligibility and reimbursement.
• Communicates professionally with state Medicaid representatives, Managed Care Organizations (MCOs), providers, hospitals, nursing facilities, and physician offices regarding

billing and reimbursement issues.

• Maintains detailed records of claim status, billing activity, and collection efforts.
• Assists with audits and reimbursement reviews as requested

Medicaid Eligibility and Benefits Verification

• Verifies Medicaid eligibility, coverage periods, spend-down requirements, and managed care enrollment.
• Verifies benefits and payer requirements for Medicaid Managed Care plans and secondary insurance coverage.
• Collaborates with Referral Specialists, Intake Coordinators, Admissions staff, and Case Managers to ensure accurate eligibility determination.
• Identifies and resolves eligibility discrepancies prior to admission and throughout the patient's episode of care.
• Documents verification details accurately within designated software and related systems.
• Communicates coverage information and authorization requirements to appropriate staff members.
• Monitors Medicaid approval, pending, and redetermination statuses as applicable

Medicaid Notifications and Authorizations

• Reviews and monitors Medicaid notifications, approvals, denials, and eligibility determination notices.
• Tracks required authorization, level-of-care determinations, and Medicaid approval documentation.
• Scans and files Medicaid notification letters and supporting documentation into the electronic medical record.
• Works with Admissions, Clinical Staff, and State Agencies to obtain required documentation for reimbursement.
• Maintains records of Medicaid approvals, discharge notifications, and regulatory reporting requirements.

Accounts Receivable Management

• Performs follow-up on unpaid or underpaid Medicaid claims.
• Maintains claim appeals and supporting documentation for denied claims.
• Identifies billing trends, reimbursement issues, and recurring claim errors.
• Communicates reimbursement concerns and recommendations to management.
• Collaborates with Clinical and Finance staff to resolve documentation deficiencies impacting payment.

Administrative Duties

• Supports the Agency's commitment to preventing fraud, waste, and abuse.
• Maintains knowledge of hospice philosophy and applicable federal, state, and payer regulations.
• Maintains Medicaid tracking and reimbursements.
• Arrivals at work and meetings prepared and on time.
• Attends required educational programs and continuing education opportunities.
• Demonstrates flexibility and adaptability in response to changing organizational needs and regulatory requirements.
• Works effectively under time constraints while maintaining quality and accuracy standards.
• Promotes positive working relationships with patients, families, referral sources, and colleagues.
• Supports the Agency's mission, vision, values, and culture.
• Performs other related duties as assigned.

Compliance and Confidentiality

• Adheres to all Medicaid, Medicaid, HIPAA, and other applicable federal and state regulations.
• Maintains confidentiality and safeguards protected health information.
• Follows Agency policies, compliance with standards, and reporting requirements
• Participates in compliance education and billing audits as required

Physical and Mental Requirements

The Employee Must Be Able To

• Communicate effectively in English through verbal and written communication.
• Hear and understand normal conversations in person and by telephone.
• See with sufficient visual acuity to review records, computer screens, and documentation.
• Use hands, wrists, and fingers continuously for typing, writing, data entry, and operation of office equipment.
• Sit for extended periods while performing computer-based work.
• Maintain concentration, accuracy, and attention to detail in a fast-paced environment.
• Manage multiple priorities and deadlines effectively.

Qualifications Education

• High School Diploma or equivalent required.
• Postsecondary coursework in Medical Billing, Coding, Health Information Management, or related field preferred.

Experience

• Minimum of three (3) years of experience working with Medicaid billing and reimbursement.
• Knowledge of hospice billing practices is strongly preferred.
• Experience with Medicaid and commercial insurance billing is preferred.
• Experience working with electronic health records and billing software required.

Experience with claims follow-up, denial management, and accounts receivable processes preferred.

Knowledge, Skills, And Abilities

• Strong understanding of Medicaid regulations claims processing, and reimbursement guidelines.
• Strong computer skills, including proficiency with Microsoft Office applications and billing systems.
• Excellent organizational and time management skills.
• Ability to prioritize workload and meet deadlines.
• Strong analytical and problem-solving abilities.
• Excellent verbal and written communication skills.
• Ability to maintain confidentiality and professionalism.
• Ability to work independently and collaboratively within a team environment.
• Strong attention to detail and commitment to accuracy