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Revenue Specialist, Out of State Medicaid

1 hour, 52 minutes ago
United States
Full-time
Junior
Accountant
Operations
HIPAA
Apply Now
EnableComp

EnableComp

EnableComp specializes in complex claims and specialty revenue cycle management solutions for healthcare providers, focusing on optimizing reimbursements for various claims types, including VA, Workers' Compensation, and Motor Vehicle Accidents, throug...

Insurance
251-1K
Founded 2000
View All Jobs 14

Description

  • Verify patient eligibility when needed.
  • Analyze and evaluate Medicaid claim payments using company systems and tools.
  • Review payment documentation and state fee schedules to confirm proper reimbursement.
  • Research, request, and submit supporting medical records and documentation with hospital claims.
  • Review UB-04 billing components for accuracy and make required changes in line with billing laws.
  • Conduct timely follow-up with payers to confirm receipt of claims and supporting documentation.
  • Prepare and submit initial Medicaid bill packets using EnableComp systems and tools.
  • Analyze account delinquencies and activity to support timely and accurate payments.
  • Work with insurers and outside entities to request authorizations and support concurrent review activities.
  • Appeal claim denials and underpayments as needed.

Requirements

  • High school diploma or GED required; associate’s or bachelor’s degree preferred.
  • 1-2+ years of experience in the healthcare field working in billing or collections.
  • 1+ years of client-facing or customer service experience.
  • 1+ years of experience with UB-04 billing and collections required.
  • CMS-1500 billing and other complex claims experience is a plus.
  • Intermediate understanding of insurance payer/provider claims processing and related data requirements.
  • Intermediate understanding of Medicaid payers preferred.
  • Strong computer proficiency, including MS Office (Word, Excel, and Outlook).
  • Proven written and verbal communication skills, strong analytical and problem-solving skills, and the ability to manage multiple priorities.
  • Must be able to work independently, maintain regular attendance, and perform essential duties satisfactorily.

Interested in this position?

Apply directly on the company website

Apply Now

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