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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