Job Role Summary

This position provides billing and coding services at the ACTION health center (adolescent clinic) and is responsible for processing Medicaid and other third party insurance claims and invoices for reimbursement to generate revenues. The Reimbursement Specialist oversees the fee collection process and collects, monitors and controls data relevant to the fee collection system and insurance billings. This position is responsible for assisting patients in applying for health coverage. This position provides follow-up on Medicaid risk based managed care referrals and authorization for payment.

Associated Job Duties

• Processes referrals for RBMC/Medicaid
• Receives calls from outside providers who request authorization for payment through Medicaid networks 
• Processes request to Medicaid for approval of referral authorization 
• Files claims electronically and on paper for reimbursement
• Assists applicants in completing application form for Hoosier Healthwise/Medicaid enrollment
• Compiles reimbursement reports
• Instructs staff on fee collection, patient eligibility, billing and managed care referral procedures in addition to Hoosier Healthwise enrollment applications
• Maintains contact with clinic personnel to advise of current procedures and practices relevant to fee collection or insurance billing
• Provides in-service orientations for fee collection system and required updates
• Trains clinic personnel on billing software updates or new procedures
• Stays current on insurance/carrier policies and filing limits and status of patients’ eligibility changes
• Maintains up to date logs and files of documentation
• Posts record of payment to each individual patient account
• Prepares monthly revenue reports of payments received and amount billed
• Develops and maintains alpha numeric files including patient encounter forms, monthly reports, special projects, insurance provider information, bulletins, etc.  
• Develops and updates relevant forms, reports, patient encounter forms, etc. when changes occur to ICD-10 and CPT codes and new program or projects
• Assists Director of Finance and Medical Director on special projects
• Cross-trained in all aspects of billing to assist in Dental and Immunization Billing
• Maintains provider status and updates, required for billing insurance, license and DEA numbers and applying for new provider status with insurance carriers

Qualifications

• Demonstrated 3 to 5 years of related experience.  
• Specialized education/training normally acquired through up to 18 months
• Medical terminology
• Thorough knowledge of Medicaid enrollment/billing requirements

Licenses/Certifications Required

Certification in Coding and Billing preferred

Knowledge, Skills & Abilities

• Knowledge of ICD-9-CM and ICD-10-CM CPT, HCPCS coding procedures
• Demonstrated 3 to 5 years of related experience.
• Specialized education/training normally acquired through up to 18 months
• Medical terminology
• Thorough knowledge of Medicaid enrollment/billing requirements
• Strong interpersonal skills, written and verbal communication skills including ability to present results and interact with executive staff.