Managed Medicaid Specialist

Medicaid Managed Care Specialist

SUMMARY:

The Medicaid Managed Care Specialist works to review, investigate and follow-up on various insurance claims.

• Ensure that established accounting procedures are followed for processing insurance claims
• Check for accuracy of information for claim submission
• Monitor claims processing status, recorded payments and adjustments within the billing system
• Maintain accurate records, up to date billing systems
• Manage and submit appeals, calls, emails and other efforts to obtain insurance coverage payment
• Follow-up on, collect and allocate payments as applicable
• Perform collections follow-up process in accordance with established procedures
• Research and resolve denied claims in a timely fashion
• Investigate and resolve customer queries and communicate with customers via phone, email, mail or personally
• Assist with preparation of monthly statements or as requested by supervisor
• Other duties as assigned

• Experience in Long Term Care industry, preferred
• Experienced in Managed Medicaid billing
• Experience in Point Click Care (PCC) billing system is preferred

• Must be able to move intermittently throughout the workday.