Medicaid Analyst

Job Category:

Healthcare, Billing

Pay: TBD

Overview

Primarily responsible for thorough review of managed care contracts and comparison of such contracts against Medicaid claims to identify underpayments for the assigned client.

Duties and Responsibilities

• Build strong, lasting relationships with clients, payors and BLS personnel
• Review insurance contracts to gain thorough understanding of payment methodologies
• Examine claims and calculate reimbursement based on contract terms to determine accuracy of payment through use of various reports and supporting documentation
• Contact insurance company to obtain missing information, explain and resolve underpayments and arrange for payment or adjustment processing on behalf of client
• Prepare and submit correspondence such as letters, emails, online inquiries, appeals, adjustments, reports and payment posting
• Maintain regular contact with necessary parties regarding claims status including payors, clients, managers, and other BLS personnel
• Direct claims to and coordinate and support BLS specialty units
• Attend client, department and company meetings
• Comply with federal and state laws, company policies and procedures

Skills and Experience

• Minimum 3-years Medicaid experience working with claims and/or billing
• Accounts receivable/follow-up experience
• Moderate computer proficiency including working knowledge of Microsoft Word and Excel
• High school diploma or equivalent
• Mathematical skills: ability to calculate rates using addition, subtraction, multiplication and division
• Ability to read and interpret an extensive variety of documents such as contracts, claims, instructions, policies and procedures in written (in English) and diagram form
• Ability to write routine correspondence (in English)
• Ability to define problems, collect data, establish facts and draw valid conclusions
• Strong customer service orientation
• Excellent interpersonal and communication skills
• Strong team player
• Commitment to company values
• Associate or Bachelor’s Degree preferred but not required

Company – Revecore