Masis Professional Group is assisting our client in searching for a Billing & Eligibility Specialist.
The Billing and Eligibility Specialist is responsible for the submission and processing of managed care claim batches and payment files, maintaining claim, and payer remittance files for assigned programs and coordinating with finance and program staff on claim denials, reviews, appeals and resubmissions.
This position is also responsible for performing batch MassHealth eligibility checks for assigned programs.
Duties and Responsibilities:
- Be knowledgeable of and comply with all applicable state, federal and agency regulations, policies and procedures pertaining to elder services and company mission.
- Bill Senior Care Options (SCO), OneCare and other assigned plans for case management services.
- Generate monthly Case Management invoices in the SCO Database to be approved by the SCO Director.
- Together with program supervisors and administrative teams, resolve consumer Case Management record inconsistencies between databases.
- Work with SCO and program staff to ensure all required consumer information is in SIMS for the monthly billing.
- Maintain accurate billing records in the SCO database for Case Management, training and additional billable activity.
- Process electronic payment files and maintain payer remittance folders. This includes submitting daily payment summary reports to the Accounting Supervisor for posting.
- Reconcile payments and research payment denials. Assist other billing specialists with SCO, OneCare and PACE appeals and claim follow-up as needed. Act as primary contact for SCO and OneCare claims related questions.
- Together with A/R document agency payment discrepancies for assigned programs. Works with billing specialists to follow up on payment or retraction status.
- Maintain database or spreadsheet claim and payment history. Identify denial trends for review by program staff.
- Responsible for performing batch MassHealth eligibility checks. Interface with various programs, finance and quality teams as necessary.
- Prepares reports as requested by Director of Finance and the management team.
- Backup for other department staff as needed to support the billing processes. This includes cross training on MassHealth fee-for-service claims.
Experience and Educational Requirements:
- Clerical skills including: accuracy in communications, e.g., spelling, proper written formats, and typing skills; ability to operate office equipment, e.g., copy machine, fax machine, and computer; and has knowledge of record keeping.
- Three years of related work or a bachelors degree in accounting, business or related field is preferred.
- Possesses working knowledge of Google products and Microsoft Office.
- Ability to learn multiple database applications.
- Possesses the willingness and ability to become familiar with appropriate information, regulations and procedures relative to related programs.
- Possesses the ability to effectively communicate verbally and in writing.
- Possesses the ability to organize, prioritize and work with minimal supervision.
- Has the ability to effectively cope with a variety of personalities and other stress provoking factors.
- Has the ability to interpret, understand and adhere to the regulations, standards and procedures as set forth by the Agency.
- Must be able to work effectively in a changing environment
- Satisfactory background check that includes CORI, SORI, SAMs GSA, Mass Health Exclusion List and OIG check.
- Valid drivers license required. Vehicle available during all working hours. Vehicle should be Registered and inspected in accordance w 540 CMR 4.00.
Please submit your resume to be considered for this opportunity.
Job Type: Full-time/Direct Hire
Pay: $21.00 - $24.00 per hour