Billing and Adjudication Specialist
Elderwood Health Plan

Job Info

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Join Our Team: Are you ready to change your life with a rewarding career move ? Overview:

The Billing Specialist provides administrative support to the health plan department by assisting with processing and resolving invoices based on state rejections and delinquent accounts, conducting audits, and submitting monthly billing to the state and monthly spenddown invoices to members. This individual communicates with clients and providers regularly.

Responsibilities:

• Generates and submits monthly roster of invoices to state for payment
• Generates and distributes monthly Spenddown and NAMI invoices to members with balance due.
• Manages the outstanding Accounts Receivable for both Medicaid Capitation Payments and Spenddown/NAMI.
• Troubleshoots Medicaid Capitation Payments that denied or paid in errors.
• Connects with members who are delinquent in payment.
• Assists providers with inquiries in an efficient and timely fashion.
• Provides superior customer service.
• Completes audits as directed for Member Medicaid Recertification, missing required documentation (CDPAP Orders, etc)
• Utilizes electronic timekeeping system as directed.
• Supports and abides by Elderwood's Mission, Vision, and Values.
• Abides by Elderwood's businesses code of conduct, compliance and HIPAA policies.
• Performs other duties as assigned by supervisor, management staff or Administrator.

Qualifications:

• Minimum of Associates degree in Billing, Business or related field
• Minimum two (2) years of medical billing/collections experience (long term care or health insurance plans preferred)
• Minimum one (1) year customer service experience
• Demonstrated telephone customer service experience desired
• Demonstrated proficiency with Microsoft Office programs including Excel, Word and Outlook
• Prior experience working with third party payors preferred

Employee Perks!: 401K Retirement Plan with Company Match, Free On-Site Parking, Generous PTO & holiday package, Life Insurance, Medical, Dental, and Vision insurance, Point-earning employee reward program: redeem for prizes!, Strong leadership EOE Statement: WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

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