Medicaid Biller and Analyst - Pat Financial Serv - FT Days

Job Summary: Bills Illinois Medicaid claims and State of Illinois Sexual Assault claims., as well as some out-of-state Medicaid processing. Billing includes Anderson Hospital, Maryville Imaging, and Anderson Home Health claims. Reviews and analyzes unpaid claims, determining action steps for follow-up and claim resolution. Processes payor denials and resubmits corrections to resolve denial. Processes and resolves credit balances. Processes claim edits, as well as late and lost charges.

Job Responsibilities:

• Bills all Illinois Medicaid , Sexual Assault claims, and some out-of-state Medicaid processing, regardless of patient status or bill type.
• Bills claims accurately and in compliance with state and federal regulations and guidelines.
• Reviews and analyzes unpaid aging Medicaid claims utilizing Meditech automated reminders. Utilizes appropriate website to determine claim adjudication status at IDPA. Determines current account status, and determines necessary action steps to expedite claim payment by Medicaid. Utilizes Explanations of Medicaid benefits in the analysis of account status. Escalates problem accounts to team leadership.
• Reviews and analyzes all Medicaid denials in the Denials Manager software application, determining necessary action to correct and resubmit claim or other necessary claim resolution.
• Reviews and analyzes all Medicaid credit balances and takes necessary action to accurately and compliantly resolve the credit balance.
• Reviews and analyzes all Medicaid and other assigned claim group late and lost charges and determine necessary action to bill or adjust charges in compliance with hospital policy.
• Participates in department education regarding Medicaid changes and standards, and maintains a current knowledge of Medicaid billing requirements.
• Identifies and recommends opportunities for process improvement in Patient Financial Services, or other Revenue Cycle departments, as related to the PFS processes.

Service and Quality Standards:

Service

Is Customer focused

Anticipates customer needs

Adheres to customer service standards

Is Competent, caring and compassionate

Treats coworkers and customers with dignity and respect

Demonstrates competent, caring and compassionate behavior

to customers and coworkers

People

Is conversation conscious

Assures confidentiality of patient and employee information

Is positive in interactions with others

Is courteous and respectful

Promotes a harassment free environment

Inspires the trust of others

Acts in accordance with hospital policies, meets the requirements of the Code of Conduct, and identifies any conflicts of interest.

Quality

Is excellent in patient care and service

Demonstrates multidisciplinary cooperation

Assists in obtaining excellent satisfaction scores of feedback

Is safety conscious

Demonstrates safety consciousness and supports safety initiatives

Is involved with improvement efforts

Supports performance improvement

Seeks ways to improve systems and services

Shows commitment to improvement efforts

Meets mandatory educational requirements

Growth

Is a loyal ambassador

Demonstrates commitment to hospital mission and vision

Is active and involved

Supports hospital initiatives

Champions innovation and supports change

Is a positive role model

Fosters team cooperation

Finance

Is a good steward of hospital resources

Develops/uses efficient work methods

Is cost effective

Conserves organizational resources

Education Requirements and Other Requirements:

Education Level:

High school diploma or equivalent.

Certification/Licensure: N/A

Experience Requirements:

Previous experience in Medicaid billing preferred.

Previous experience in Medicaid follow-up and/or denials processing preferred.

Previous experience in hospital patient accounts experience preferred.

Office procedures and keyboarding minimum 50 wpm preferred.

Microsoft Word and Excel experience preferred.

Other computer and organizational skills preferred.

Meditech experience helpful.

Working Conditions: Exposure Category III: Tasks that involve no exposure to blood, body fluids, or tissues, and Category I tasks are not a condition of employment. The normal work routine involves no exposure to blood, body fluids, or tissues. Persons who perform these duties are not called upon as part of their employment to perform or assist in emergency medical care or first aid or to be potentially exposed in some other way.