Billing Representative

• Location 501 Comfort Place,Mishawaka, IN, 46545,United States
• Employee Type 5
  
  Days/8
  
  Hrs

Not a Remote position

FLSAStatus: Non- exempt

Toensuretheaccurateandtimelyprocessingof Medicaid billing, accountsreceivablemanagement, payment posting,benefit verification,andreimbursementfollow-upactivitiesinsupportofthe

Agency's financial operations and regulatory compliance.

• 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 filledoutproperlyand signed byall appropriate staff members.
• Reviewsclaimsforaccuracy, completeness, andcompliancewithstate
  
  Medicaidrequirementsprior to submission.
• Research,resolves,andfollowsupondenied,rejected,suspended,orunpaid
  
  Medicaid claims.
• Monitorsaccountsreceivable reports andperformtimelyfollow-upon outstanding balances.
• Communicates professionally with state Medicaid representatives, Managed Care Organizations (MCOs), providers, hospitals, nursing facilities, and physician offices regarding billing and reimbursement issues.
• Assistswithauditsandreimbursementreviewsas requested
• Verifies Medicaid eligibility, coverage periods, spend-down requirements, andmanagedcare enrollment.
• Verifies benefits and payer requirements for Medicaid Managed Care plansand secondary insurance coverage.
• Collaborates with Referral Specialists, Intake Coordinators,Admissions staff,andCaseManagersto ensure accurate eligibility determination.
• Identifies and resolves eligibility discrepancies prior to admission andthroughoutthepatient's episode of care.
• Documentsverificationdetailsaccuratelywithindesignatedsoftwareandrelated systems.
• Communicates coverage information and authorization requirements to appropriate staff members.

• Reviewsandmonitors Medicaid notifications,approvals,denials,and eligibility determination notices.
• Tracks required authorization, level-of-care determinations, and Medicaid approval documentation.
• Scansandfiles Medicaidnotificationlettersandsupportingdocumentationintothe electronic medical record.
• Workswith Admissions,Clinical Staff,andState
  
  Agenciestoobtain required documentation for reimbursement.

• Performs follow-up on unpaid or underpaid Medicaid claims.
• Communicates reimbursement concerns and recommendations to management.
• Collaborates with Clinical and Finance staff to resolve documentation deficiencies impacting payment.

• Supports the Agency's commitmenttopreventing fraud,waste,and abuse.
• Maintainsknowledgeofhospicephilosophyandapplicablefederal,state,andpayer regulations.
• Arrivalsatworkandmeetingspreparedandon time.
• Attends required educational programs and continuing education opportunities.
• Demonstratesflexibilityandadaptabilityinresponsetochangingorganizationalneedsandregulatoryrequirements.
• Promotespositiveworkingrelationshipswithpatients,families,referral sources,and colleagues.
• Performs otherrelateddutiesas assigned.

• Adheres toall Medicaid, Medicaid,HIPAA, andotherapplicablefederaland state regulations.
• Maintains confidentiality and safeguards protected health information.
• F ollows Agency policies, compliance with standards, and reporting requirements
• Participatesincomplianceeducationandbillingauditsasrequired

Theemployeemustbeable to:

• Communicate effectively in English through verbal and written communication.
• Hearandunderstandnormalconversationsinpersonandby telephone.
• Seewithsufficientvisualacuitytoreviewrecords,computer screens,and documentation.
• Usehands,wrists,andfingerscontinuouslyfortyping,writing,dataentry,and operation of office equipment.
• Sit…