Process all Payors claims and eligibility files bi-monthly. Research errors and rejections. Maintain correct payor set-ups for those covered under CCHA Medicaid. Follow up on denials and submit appeals for payment. Work with the RC Manager to reconcile services in EHR to CCHA. Call for verifications and authorizations. Work various month end reports. Provide customer service to clients, therapists and outside providers. Back up in the department for other positions.
Responsible for Medicaid CCHA
- Admits Pending – daily
- Check widgets daily, at the beginning and end of the day.
- Verify that we have all the necessary information, the authorization is entered, financial page is signed and unpend the payor.
- Insurance Verifications
- Complete insurance verification process on EHR
- Help out other staff members on verification per schedule.
- As scheduled, check faxes and regular mail and distribute
- Claim review bi-monthly: Medicaid CCHA
- Review the clearinghouse and CCHA accept/reject reports for the electronic claims. Fix any reject issues and set to rebill.
- Follow-up on denials/appeals and rebill monthly.
- Run the Claims process and Eligibility files bi-monthly:
- Make sure all the claims are processed and submitted to the Clearinghouse and HCFAs printed. Review all follow up reports and correct any errors.
- Insurance authorizations
- For those who need an authorization, obtain auth and enter into EHR
- Follow–up as needed to extend or add services to authorizations.
- Monthly reports and reconciliations
- Monthly Aging report.
- Research various other monthly reports such as Closed client, Collections report, Credit balance report, etc
- Complete monthly reconciliations.
- Medicaid Bulletins
- Read Medicaid bulletins to stay updated on changes.
- Customer Service
- Research client inquiries and resolve in a timely manner.
- Help those in the outside offices with questions.
- Abide by JCMH customer service policies and principles.
- Other duties as assigned.
Note: Employees are held accountable for all duties of this job. This job description is not intended to be an exhaustive list of all duties, responsibilities, or qualifications associated with the job.
- High School Diploma/GED required.
Required Work Experience:
- Experience with the overall billing process: claims- electronic and paper, authorizations, payment posting, CPT coding, benefit verifications and explanation of benefits adjustments.
- Experience with aging reports and general ledger reconciliations.
- Excel experience is required.
Technical Skills and Knowledge:
- Knowledge of Insurance and managed care companies, Medicare and Medicaid.
- Good computer and customer service skills are required.
- Basic knowledge of mental health vocabulary.
- Basic Accounting skills.
- Able to contribute and be part of a team.