MedData has an excellent career opportunity available as a OOS Claims Specialist. This position is located in our regional office in Draper, UT. The schedule for this Full Time role is Monday - Friday 8 AM to 5 PM.
SUMMARY
MedData provides revenue cycle solutions to hospitals and physicians throughout the United States. This includes AR support for Out-of-State Medicaid accounts. The purpose of this position is conduct Medicaid eligibility, authorization, billing and follow up functions.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Properly identify Medicaid eligibility, authorization, enrollment and documentation requirements for hospital and physician accounts. Training and software to assist with these functions will be provided.
- Submit authorization requests to Medicaid payers and perform appropriate follow up to ensure authorization requests are resolved in a timely manner.
- Perform manual data entry of patient accounts and or claim forms.
- Obtain bills, medical records or other necessary documentation from medical providers in a timely manner.
- Review and edit claims to ensure they meet state and federal guidelines.
- Submit claims timely and accurately to Medicaid payers.
- Perform aggressive follow-up on unresolved claims.
- Facilitate timely payment from Medicaid payers.
- Research denials and/or underpayments and formulate appeal letters and/or disputes to Medicaid plans in accordance with state guidelines.
- Submit payment details to the cash posting team.
- Work in compliance with state and federal guidelines, including HIPAA and FDCPA.
- Maintain case clear, concise and accurate account notation.
- Monitor the status of accounts and communicate effectively with management, clients and other parties regarding the status of the accounts.
- Provide responses to client inquiries within 24 hours.
- Other duties as assigned.
QUALIFICATIONS AND REQUIREMENTS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or abilities.
- High School Diploma or GED.
- Working knowledge of ICD9, CPT codes, HIPAA, HCPCS and Medicaid preferred.
- 1-2 years of related experience in the healthcare industry or in a related area.
- Excellent verbal and written communication skills.
- Strong organizational skills.
- Ability to multi-task.
- Critical thinking and strong attention to detail.
- Required computer skills: must have experience with data entry and word processing, be capable of operating routine office equipment, possess a working knowledge of MS Office applications, and understand how to navigate through multiple web-based applications.
PHYSICAL DEMANDS:
The physical demands described here are representative of those that must be met by an Employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the Employee is frequently required to sit; use hands to finger, handle, or feel; and reach with hands and arms. The Employee is occasionally required to stand and walk and must occasionally lift and/or move up to 20 pounds.
The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or a logical assignment to the position.
This job description is to serve as a guide but no way is it to be considered a comprehensive list of task, duties and responsibilities that will be required by the employee.
To join our team of 2,000 employees and growing, please apply directly to this posting.
MedData is an Equal Opportunity Employer
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