*** WAIVER EXPERIENCE NEEDED***
Open to work in office, hybrid, or remote.
Summary/Objective
Performs all activities in coordination with Director Finance related to Claim Management for entities that the agency bills for services including Medicare, Medicaid, Managed Care, CHOICE, Older Americans Act, private-pay, and others. Maintains current knowledge of insurance payors to maximize reimbursement. Investigates denial and appeal issues and past-due appealed claims to optimize revenue performance in a timely manner.
Essential Duties/Responsibilities
· Track claims in real-time for department and evaluate issues affecting reimbursement as it relates to denial including investigate, evaluate, negotiate, and settle.
· Prepare reports in a timely and accurate manner for the State including claims for reimbursement, quarterly non-federal report, two-year compare, and all other required reporting.
· Submits charges and claims for services through specialized software, working rejections, processing and posting payments, handling program/patient billing inquiries, and ensuring claims are processed in a timely and effective manner.
· Develop and maintain proficiency on tools required to perform job tasks in a timely and accurate manner including specialized computer software.
· Develop and maintain depth of knowledge of accounting principles and practices, especially as they apply to billing for services.
· Regularly review program for compliance with all applicable guidelines, policies, standards, laws and regulations, and provide results to Director Finance.
· Ensure timely knowledge and understanding of new rules and regulations that affecting claims processing.
· Develop and maintain an accurate and thorough knowledge of all agency standards procedures, policies including Fiscal Department accounting standards and processes, and specialized computer software related to accounting functions specific to the agency and department-level contracts.
· Design Excel spreadsheets and maintain current Excel spreadsheets.
· Process all agency billing including Medicaid Waiver and other State funding in an accurate and timely manner ensuring codes are correctly assigned per government and insurance regulations.
· Communicate with supervisor on daily basis, and as needed, to report all areas of concern/issues/incidents.
· Serve as an example of agency Standard of Excellence by exemplifying agency vision and goals.
· Demonstrate professionalism in relationships with customers/co-workers/supervisors to build rapport while refraining from inappropriately familiar personal relationships.
· Comply with HIPAA and agency confidentiality policies and report any potential issues immediately.
· Complete and attest to accuracy of payroll records and submit for review and processing according to agency schedule.
Required Education and Experience
Minimum two years’ experience working and processing claims in medical/ insurance/ community organization. Computer proficiency in HCP Provider Portal for Medicaid Waiver. Must be proficient in creating and manipulating Excel spreadsheets. Must be familiar with Microsoft Office products and accounting software, such as QuickBooks or MIP.
Preferred Education and Experience
Four years’ experience in claims management with organization processing 10.000+ claims per month. Experience in fund accounting. Bachelor’s degree in accounting, or related field of study.
Benefits:
- 403(b)
- Dental insurance
- Employee assistance program
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Retirement plan
- Vision insurance
- Work from home
Experience:
- Medicaid Waiver billing: 5 years (Required)
Work Location: Hybrid remote in Fort Wayne, IN 46804
