Hybrid Accounts Receivable /Medicaid Claims Specialist bei Pueblo Diversified Industries

Description

SERVICE PHILSOPHY 

Pueblo Diversified Industries (“PDI”) is a Colorado Nonprofit Corporation with a mission to create pathways of opportunity where people with diverse abilities thrive through informed choices, meaningful education and employment, premier residential services, and dynamic social experiences. Pueblo Diversified Industries is an Equal Opportunity Employer. 

SUMMARY 

Accounts Receivable/Medicaid Claims Specialist has primary and broad-based responsibility to support the PDI CFO in carrying out the duties and responsibilities of the finance department. 

Our healthcare organization seeks a highly organized and detail-oriented Accounts Receivable and Medicaid Claims Specialist to join our team. A successful candidate will be responsible for submitting claims to Medicaid, inputting billing information into an electronic database, and resolving disputed claims and discrepancies. In addition to Medicaid billing, the organization also handles billing and payment processing for federal services and commercial contracts. 

• Review all client files and assign codes to each service given.
• Input billing information into an electronic database and bill Medicaid carriers.
• Submit claims to Medicaid.
• Ensure accurate billing and timely submission of electronic and/or paper claims.
• Resolve disputed claims and discrepancies by conducting research and initiating corrective action.
• Consult with the Medicaid office to review remittance advice and adjust patient bills.
• Prepare monthly summary reports of Medicaid billing, adjustments, and revenue.
• Participate in continuing education and maintain knowledge of current Medicaid billing and reimbursement procedures.
• Maintain security procedures and confidentiality to protect patients.
• Monitor claim status, researching rejections and denials, documenting related account activities, posting adjustments and collections of Medicare, Medicaid, Medicaid Managed Care, and commercial insurance payers.
• Consult with the Medicaid office to review remittance advice and adjust patient bills.
• Preparing monthly summary reports of Medicaid billing, adjustments, and revenue.
• Rep Payee for our individuals, managing benefit payments, and keeping accurate records.
• Data Entry, maintaining electronic and paper records. 
• Other duties as assigned

Requirements

REQUIREMENTS

• Pass a pre-hire drug and background screen, 
• Random drug screens that will occur at any time and without notice while employed by PDI. 
• You must be computer-literate, comfortable with technology with well-developed oral and written communication skills.
• You must be age 18 or over to work at PDI. 
• Have a high school diploma or GED
• Minimum of 1 year of AR/AP experience
• Ability to type 45 words per minute
• Proven ability to multitask and stay organized under pressure
• Ability to work in a team environment
• Medicaid billing experience preferred
• PDI has specific requirements for employees who drive on company business. 
• Summary of the requirements: 

Driving a PDI Vehicle/Driving a Personal Vehicle on PDI Business:

• Must possess a valid driver’s license.
• Must agree to a review of your motor vehicle record for addition to PDI’s authorized drivers' list.
• Must provide proof of automobile insurance.

These requirements ensure that all drivers are properly licensed and insured, maintaining safety and compliance standards.

Associate’s degree in accounting from an accredited college and two years of documented experience in an accounting office or department. Solid background in Microsoft Windows-based information technology environment with highly developed skills in utilizing Microsoft Excel spreadsheets. Ability to learn and become proficient in other accounting and payroll systems utilized by PDI. 

LANGUAGE

The candidate must have the ability to read, analyze, and interpret complex documents and general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information, and respond to questions, common inquiries, or complaints from groups of managers, clients, customers, regulatory agencies stakeholders, and the general public. Ability to respond effectively to the most sensitive inquiries or complaints. 

MATHEMATICS ABILITY 

Highly skilled in analyzing and dealing with financial and numeric data. Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations. 

COMPUTER SKILLS 

To perform this job successfully, an employee must have high-level knowledge of the Microsoft Office suite of products, Internet software, communications systems, and specialized software specific to the employee’s area(s) of responsibility. 

REASONING ABILITY 

Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in the mathematical, written word, or diagram form and deal with several abstract and concrete variables. 

WORK ENVIRONMENT 

The Medicaid Claims Specialist - works in the main PDI facility. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. 

While performing the duties of this job, the Accounting Specialist -- is occasionally exposed to outdoor weather conditions and occasionally exposed to wet or humid conditions (non-weather). The noise level in the work environment is usually moderate but can often be elevated and hectic. 

POSITION TYPE AND EXPECTED HOURS OF WORK 

This is a non-exempt full-time position. Expected hours of work are 7:30 a.m. until 4:00 p.m. Monday through Friday. Occasional weekend and/or after-hours work is required. 

PHYSICAL DEMANDS 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. 

The Accounts Receivable/Medicaid Claims Specialist must often lift and/or move up to 25 pounds, rarely lift and/or move up to 50 pounds, and very rarely lift and/or move up to 100 pounds with the aid of an assistive device. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception, and the ability to adjust focus. While performing the duties of this Job, the Accounts Receivable/Medicaid Claims Specialist is regularly required to reach with hands and arms and talk or hear. The is frequently required to stand; walk; sit; use hands to finger, handle, or feel; climb or balance and stoop, kneel, and crouch.