Job Description

Job Title:

Medicaid Billing Specialist

Work Location:

Pafford Medical Services, Inc. Corporate Office

Division / Department:

PMBS

Reports To:

Team Lead

Employment:

Full-Time, Nonexempt

Job Description:

Pafford Medical Services is seeking a detail-oriented and experienced Medicaid Billing Specialist / Follow Up Specialist to join our team. This role is crucial in ensuring the timely and accurate processing of Medicaid claims and follow-up activities. The ideal candidate will have a strong background in medical billing, particularly with Medicaid, and be adept at resolving claim issues and discrepancies.

Essential Duties and Responsibilities:

• Medicaid Billing:
  
  • Accurately prepare and submit Medicaid claims for services rendered by Pafford EMS.
  • Ensure all claims are coded correctly and comply with Medicaid regulations and guidelines.
  • Monitor and verify patient eligibility and insurance coverage.
  
  
  
• Follow-Up and Claim Resolution:
  • Conduct follow-up on outstanding claims and ensure timely resolution of billing issues.
  • Communicate with Medicaid offices, patients, and other relevant parties to resolve claim discrepancies, denials, or rejections.
  • Review and appeal denied claims, providing necessary documentation and information.
  
  
  
• Record Keeping and Reporting:
  • Maintain accurate and up-to-date records of billing activities, payments, and follow-ups.
  • Generate regular reports on billing status, outstanding claims, and payment trends.
  
  
  
• Compliance and Continuous Improvement:
  • Stay informed about changes in Medicaid regulations and billing procedures.
  • Participate in training and development opportunities to enhance knowledge and skills.
  • Recommend and implement process improvements to enhance billing efficiency and accuracy.
  
  
  
  
  

Qualifications:

• Minimum of 2-3 years of experience in medical billing, with a focus on Medicaid billing and follow-up.
• In-depth knowledge of Medicaid regulations, coding (ICD-10, CPT), and billing procedures.
• Experience with medical billing software and electronic health record (EHR) systems.
• Strong analytical and problem-solving abilities.
• Excellent attention to detail and accuracy.
• Effective communication and interpersonal skills.
• Ability to work independently and manage multiple tasks.
• Proficiency in Microsoft Office Suite (Word, Excel).

Education and Experience Requirements:

High School Diploma or GED. Minimum of 2-3 years revenue cycle management experience.

Physical Requirements:

• Ability to safely and successfully perform the essential job functions consistent with ADA, FMLA and other federal, state and local standards, including meeting qualitative and/or quantitative productivity standards.
• Ability to maintain regular, punctual attendance consistent with ADA, FMLA and other federal, state and local standards.
• The employee may occasionally be required to lift and/or move up to 20 pounds.
• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
• Work may require sitting, lifting, stooping, bending, stretching, walking, standing, pushing, pulling, reaching, and other physical exertion.
• Must be able to talk, listen and speak clearly on telephone.
• Must possess visual acuity to prepare and analyze data and figures, operate a computer terminal, and operate a motor vehicle.

Travel:

Negligible

NOTE: The above statements are intended to describe the general nature and level of work being performed by the person assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties, skills and physical demands required of personnel so classified.

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