Billing Analyst

CommonSail Investment Group

Position Summary

The Billing Analyst coordinates Medicaid claims submission for the company. Primary responsibilities include financial oversight of Medicaid revenue, contract negotiation, recredentialing, claims submission, monitoring outstanding receivables for both private pay and Medicaid amounts due, and working collaboratively to ensure timely payments are received.

Responsibilities

• Shared financial oversight of Medicaid billings and collections
• Contract negotiation
• Recredentialing of MCO renewals
• Assist with new community enrollments
• Submit Medicaid claims monthly and investigate outstanding/denied claims
• Ensure billing accuracy for dates and services rendered
• Manage MCO payments and work to get 100% of claims paid through ACH vs check
• Maintain digital repository of service authorization and spreadsheets to ensure accurate billing rates
• Update billing system to reflect any change in daily rates
• Update billing system to reflect resident days out of the community
• Collaborate with community to ensure residents receive timely communication if converting to Medicaid
• Proactively look for new service authorizations prior to expiration to ensure continuous claim submission and payment
• Work with case manager to ensure new authorizations are received upon expiration
• Maintain accurate spreadsheets of Medicaid residents, service authorization information, fees, and dates of billing
• Apply Medicaid payments in billing system
• Bill residents for required spend downs
• Contact Medicaid providers to request information, ask questions about payments and service authorizations
• Review Medicaid accounts receivable aging reports and work to resolve any denied or unpaid claims
• Verify and reconcile Medicaid payments received
• Work with clinical team to ensure service authorizations are consistent with care plans and provide discrepancy reporting to clinical and operations team
• Assist communities with monitoring and provide reporting on residents migrating from private pay to Medicaid or other government programs
• Assist with non-Medicaid accounts receivable collections processes
• Assist with general accounting and financial reporting
• Other duties as assigned

Qualifications

• Bachelor’s Degree in related field preferred
• 2+ years of experience in Medicaid billing
• Strong computer and software skills
• Familiarity with Medicaid billing procedures and regulations
• Excellent attention to detail and must maintain accuracy
• Ability to work independently with minimal supervision and collaboratively as a team

General Working Conditions

While performing the duties of this job, the employee is required to communicate effectively with others; sit, stand, walk; and use hands to operate a keyboard, telephone, and other equipment. The employee is occasionally required to reach with hands and arms. This position requires the ability to review detailed documents and read computer screens. The employee may occasionally lift and/or move up to 20 pounds. The noise level in the work environment is moderate. Occasional travel may be required.

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