[Remote] Medicaid Collections Billing Specialist

Note: The job is a remote job and is open to candidates in USA. TriStar Centennial Medical Center is hiring a Medicaid Collections Billing Specialist to review, submit, and collect electronic and paper claims for state Medicaid programs. The role coordinates with authorization and clinical teams, resolves denied or unpaid claims, and ensures accurate, timely billing and reimbursement.

Responsibilities

• Submit insurance claims to individual insurance companies electronically or via paper form
• Prepare and submit clean claims to various Medicaid agencies and or assigned payers
• Use coded data to produce and submit claims
• Analyze remittance advice(s) to ensure accurate posting of rejections, payments and contractual adjustments timely
• Reviews and appeals unpaid and denied claims
• Maintain a working knowledge of payer practices and reimbursement methodologies and become a subject matter expert in assigned A/R responsibilities
• Review UB/1500 claims for accuracy and completeness and obtain missing information as needed for submission
• Identify and bill secondary or tertiary Payors
• Ability to look up ICD-10 diagnosis and CPT treatment codes from online service or using traditional coding references
• Maintain appropriate Productivity requirement(s) for their role
• Review medical records related to an IP’s clinical presentations and supporting documentation to determine elevated level of care according to claim guidelines per state
• Submit electronic and paper claims according to Medicaid and department deadlines
• Collect and enter confidential information into PARALLON’s patient management system
• Collaborate with the clinical team and further clinical resources in sharpening review strategies for stronger ISD criteria documentation insuring payor approvals

Skills

• High school diploma or GED required
• Medical Billing Certification required
• Minimum 4-5 year(s) of experience in related area required
• Medicaid billing experience, preferred
• 1-2 years acute medical center experience, preferred
• Knowledge and experience of Medicaid guidelines for In-patient admissions, preferred

Benefits

• Work from home, provided you live and perform the duties of the position within 60 miles of an HCA Healthcare Hospital in one of the listed states
• Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services
• Free counseling and referral services
• Paid time off, paid family leave, long- and short-term disability coverage, and leaves of absence
• 401(k) Plan with a 100% match on 3% to 9% of pay, based on years of service
• Employee Stock Purchase Plan
• Flexible spending accounts
• Preferred banking partnerships
• Retirement readiness tools, rollover support and financial wellbeing counseling
• Tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing
• Fertility and family-building benefits
• Adoption assistance
• Life insurance
• Supplemental health protection plans
• Auto and home insurance
• Legal counseling
• Identity theft protection
• Consumer discounts

Company Overview