Medicaid​/Medicare Consultant

Responsibilities

The Medicaid/Medicare Consultant will support Barrow Wise's Illinois DHS project and perform the following duties:

• Serves as the Medicare/Medicaid consulting expert
• Provide and manage consulting, data transfer, and claims processing services to increase federal revenues in Medicare A, B, D, and Medicaid in IDHS State Operated Facilities
• Provide revenue maximization services for Medicare A, B, D, and Medicaid
• Enhance billing and coding accuracy, claims management, eligibility verifications, regulations, and compliance with recommendations and implementation of training, new systems, processes, and automation
• Provide and manage services to process Medicare D claims and collection as required by Federal Medicare D rules and requirements; ensure a streamlined and compliant billing and collection function, including an electronic accounts receivable system specific to pharmacy claiming
• Review and assess the current Medicare Part A & B, Medicaid, claiming policies, procedures, practices, and outcomes of each State-operated facility for mental health and developmental disabilities
• Assist the State with billing Medicare Part A & B and Medicaid programs; provide IDHS with detailed information identifying those claims that the vendor submitted in an agreed-upon format and frequency
• Assist the State in the completion of annual Medicare cost reports by reviewing Medicare cost report schedules to ensure reports are completed appropriately and maximize Medicare and Medicaid cost reimbursement
• Implement processes to improve billing and claiming with the transition to State staff
• Provide recommendations as to the level and expertise necessary for individuals to conduct billing and claim to achieve optimal revenue
• Develop and deliver training, documents, manuals, and other resources required to promptly identify and correctly bill for eligible individuals served by the DHS State-Operated Facility programs
• Work as a mediator between the State and the Fiscal Intermediary NGS (National Government Services), which requires them to answer questions related to the Medicare cost reports, billings and claims
• Assist the IDHS Office of Fiscal Services with the submission of Medicare bad debt claiming
• Assist the IDHS Office of Fiscal Services with the submission of annual Medicare cost reports
• Identify additional revenue maximization opportunities for IDHS
• Develop project reports and present data to the State

• U.S. Citizenship
• Bachelor's degree
• 10 years of experience with Medicare and Medicaid claims processing systems and revenue maximization services
• Knowledge of automation in healthcare claims
• Proficient in Project Management and Business Analysis practices, principles, and tools
• Excellent written and verbal communication skills

Barrow Wise is an equal-opportunity, drug-free employer committed to diversity in the workplace. Minority/Female/Disabled/Protected Veteran/LBGT are welcome to apply.