Intake Specialist

We rely on our Intake Specialist to verify key billing information entered in PCC agrees with key billing-related information appearing in the Medicaid Pathways portal. This includes data such as the name of the Managed Care payer, patient liability amount, etc. Identifies differences between the Medicaid Pathway's portal and Point Click Care (PCC) and reports findings to facility and CBO Medicaid Biller. Tracks differences and confirms differences are resolved timely. Assists with billing, auditing accounts, and Medicaid cash posting, as needed.

Why Work For Us?

• Competitive Pay
• Excellent health benefits packages
• Career advancement opportunities
• Education reimbursement program of up to $7,500 per year

Benefits & Conditions:

• No waiting period for enrollment
• Three health plan options
• Delta Dental
• VSP Vision
• Free Basic Life Insurance
• Disability, Critical Illness, Accident & Legal Coverage
• 401(k) Retirement Plan
• Employee Assistance Program

Responsibilities:

• For all new Medicaid admissions, verify all Medicaid information entered in PCC matches information appearing in the Medicaid Pathways portal.
• Prior to monthly claim submission, for all Medicaid patients, verifies all information in PCC matches information appearing in the Medicaid Pathways portal.
• Provides timely written information to the CBO Biller and the facility Business Office Manager of differences noted.
• Tracks differences between PCC and Medicaid Pathways portal and ensures all differences are resolved, timely.
• Escalates unresolved differences that are not corrected within 15 days to the Director of the CBO.
• Identifies and reports to the Director of the CBO, those facilities that are habitual Medicaid Intake offenders of this process.
• Assist with billing, as needed.
• Assist with reconciling payments to billing, as needed.
• Assists with Medicaid cash posting, as needed.
• Assist Medicaid team in maintaining Medicaid DSO at company-established level.
• Other job tasks as assigned by supervisor

Qualifications:

• High School Diploma or equivalent, some college preferred.
• Between 4-8 years of LTC billing experience or other AR healthcare related experience.
• Must be capable of maintaining regular attendance.
• General knowledge of payer plan/product reimbursement methodology
• General knowledge of payer specific filing limits, adjusted claim filing limits and requirements of clean claim submission
• General knowledge of managed care and managed Medicaid contract terms. (i.e., participating/non-participating; reimbursement terms; reimbursement methodology; payment methodology)
• Some understanding of payer specific coding edits (FYI...PCC and Inovalon have edits however some coding will pass edits and still deny)
• General knowledge of payer portals (Availity; UHC, Humana, Anthem)
• General understanding of payer remits/EOB's details (payments, denials, copays, etc.)