Medicaid Medical Biller - Remote (EST Preferred) at TEKsystems

Preference is to work EST - M-F - flexible start and end times but on average 8am-5pm

Description:

The Accounts Receivable Representative is responsible for the follow-up on identified government and non-government claims including Medicare /Medicaid and Government HMO. The incumbent will resolve unpaid accounts in a timely and efficient manner for one or more geographical areas, while maintaining quality and productivity standards set for the Level 1 A/R Follow-up Representative.

Responsibilities:

• Review eligibility, verify insurance benefits, and/or perform insurance discovery activities required to generate a clean claim.

• Review, modify as necessary, and re-bill rejected/denied claims in “queue” by assigning appropriate insurance carrier, utilizing the billing address and/or payor prefix.

• Process “queues” within appropriate timeframes, (e.g. claims status checks, appeals of denied claims).

• Recode claims, assigning proper condition codes/ICD-9 codes/procedure codes into the Accounts Receivable Billing System and re-file claims as necessary.

• Update appropriate modifiers, based on origin and destination of trip and change insurance claims as necessary.

• Create narrative in the Accounts Receivable Billing System to document status of trip for use in claim appeal process.

• Other duties as assigned.

• Work in a spirit of teamwork and cooperation.

• Convey a sense of competence and commitment.

• Use initiative to learn new skills, enhance personal knowledge and improve communications.

• Demonstrate an ability to work well with team members.

• Communicate a willingness to help others succeed.

• Share workspace and resources as necessary.

Additional Skills & Qualifications:

• High School Diploma or GED required, Associates Degree or certificate of completion from a coding and billing school preferred. Examples: Certifications

• Minimum two years previous medical billing experience required; Medicaid and ambulance billing experience preferred.

• Medical transportation processes.

• Terminology on a PCR, Hospital Face Sheet, and/or a CAD Sheet.

• Process of signature and paperwork compliance.

• Payor-specific requirements for one or more geographical areas and/or financial classes.

• Distinctions between ALS/BLS/SCT/Gurney/Wheelchair/CCT levels of service.

• ICD-9 coding/condition codes and procedure codes.

• Government coverage guidelines, filing limits and necessary prior authorizations.

• Medical terminology and insurance terminology.

• Internal Compliance guidelines.

• Appeal levels and the redetermination process.

• HIPAA requirements.

• Proficient in the Accounts Receivable Billing System and Internet, (e.g. Internet mapping programs, eligibility websites, address search engines).

• Basic understanding of Microsoft Word and Excel.

• Communicate effectively, (both orally and in writing) in English.

Experience Level:

Intermediate Level

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About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.