Account Reimbursement Coordinator - Out of State Benefits (Hospital)

Role Summary: 

The Out of State team works with facilities across the US to process their Out of State Medicaid claims.  We focus on hospital billing and follow up, hospital and physician enrollment, as well as eligibility verifications.

Team members who work within the Account Reimbursement Coordinator (“ARC”) role are assigned to support the billing of Out of State Medicaid claims (either UB-04 or HCFA 1500 claims). ARC’s work in a collaborative environment to serve the needs of our clients. Team members will be billing and working with all Medicaid payors, including FFS and MCO plans. This is a client facing role that requires a lot of attention to detail and follow through. Additionally, based on estimated monthly client volume the Account Reimbursement Coordinator may work within a small team with a Payment Recovery Specialist to process assigned accounts in a timely manner.

Role Responsibilities:

• Prioritize workload based on follow up date, dollar amount, hospital request, aging, etc.
• Utilize multiple systems to determine patient eligibility information and demographics
• Utilize various websites for billing and coding information, as well as ICD review
• When applicable, login to hospital system (i.e. EPIC) to retrieve records, post payments and note accounts
• Process and submit claims by electronic, paper or automatic methods as dictated by payor specific guidelines
• Utilize online payor portals to retrieve remittance advice- could be combined with above
• Ensure that all accounts are maintained with accurate information and a current status update
• Identify Payor trends and issues and communicate to Team Lead/Service Line Manager
• Identify denied line( Denials) items and take necessary steps with the payor to resolve the account
• Follow up on appeals, payments, and denials/ Remove or combine with above line
• Work with OOS Leadership and OOS Account Manager to understand client expectations and specific needs as it pertains to their Out of State Medicaid accounts- ARC/OOS Acct Managers 1 in the same
• If applicable, (remove) work closely with the Payment Recovery Specialist to ensure that claims are followed up on in a timely and accurate manner
• Help implement new processes that improve workflow and team efficiency
• Attend/Facilitate client meetings (typically done via phone, but may be in person from time to time)
• Payment review and posting; Close accounts as denied or paid in full
• Document findings and status within the system? Remove
• Follow up on accounts in a timely manner consistent with identified procedures Remove/Combined
• Upload supporting documentation to the system and Client Site for reference
• Work with Payment Recovery Specialists and OOS Account Managers to determine next steps on life of claim/Remove or combine

Role Requirements:

• Familiarity with UB04 and/or 1500 claims 
• Previous experience working with Medicaid payors
• 2-4 years of Billing and/or follow up experience is preferred but not required 
• 6 months to one year of administrative or customer service experience.
• Proficient in Microsoft Office, and ability to navigate multiple systems within dual monitors
• Analytical thinker: Must be able to think critically to meet client expectations
• Fast learner who can pick up new concepts and detailed procedures  
• Strong internal and external communication skills
• Attention to detail
• Ability to work independently but also collaborate with a team as needed
• Ability to thrive in a high demand environment