EnableComp provides specialty revenue cycle management solutions for healthcare organizations, helping hospitals, health systems, and ambulatory surgery centers improve financial performance and reimbursement outcomes.
The Revenue Specialist, Medicaid is responsible for ensuring proper submission and adjudication of Medicaid claims, working within assigned deadlines and protocols. This role handles protected health information (PHI) and must maintain strict privacy, security, and HIPAA compliance.
Key responsibilities include:
- Verify patient eligibility when needed
- Analyze Medicaid claim payments using company systems and tools
- Review payment documentation to confirm reimbursement compliance with applicable state fee schedules
- Research, request, and acquire medical records and supporting documentation for claim submission
- Review UB-04 billing components for accuracy and make necessary changes in accordance with billing laws
- Conduct timely follow-up with payers by phone to confirm receipt of documentation and support reimbursement
- Prepare and submit correct Medicaid initial bill packets with required supporting documentation
- Analyze account delinquencies and activity to ensure timely and accurate payment
- Work with insurers and outside entities to verify or request authorizations and assist with concurrent review activities
- Handle confidential documentation and PHI in compliance with HIPAA
- Manage inbound and outbound calls efficiently
- Support team workflow and assist in moving work through the department
- Appeal claim denials and/or underpayments as needed
Requirements & Qualifications
Required qualifications:
- High school diploma or GED required; associate's or bachelor's degree preferred
- 1-2+ years of experience in the healthcare field working in billing or collections
- 1+ years of client-facing or customer service experience
- 1+ years of experience with UB-04 billing and collections required
- CMS-1500 billing and other complex claims experience preferred
- Intermediate understanding of insurance payer/provider claims processing and related data requirements
- Intermediate understanding of Medicaid payers preferred
- Strong computer proficiency, including Microsoft Word, Excel, and Outlook
- Regular and predictable attendance
- Ability to meet productivity targets and goals
- Strong written and verbal communication skills
- Strong analytical and problem-solving skills
- Ability to work independently without direct supervision
- Ability to prioritize and manage multiple competing priorities and projects concurrently
Location
N/A
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
Yes
Posted
2 weeks ago