Claims Research - Coordinator


DEPARTMENT

Medicaid Technical Services Contract


POSITION SUMMARY

One position located in Baton Rouge.


RESPONSIBILITIES

  • Work within the managed care section to ensure issues related to medical claims are addressed in a timely manner to ensure contract compliance by each managed care organization (MCO), as well as timely and responsive MCO and provider support.
  • Communicate with providers and other external stakeholders to improve care delivered and to address Medicaid programmatic issues.
  • Serve as liaison with the MCOs and LDH MMIS, Eligibility and Systems staff to address questions and complaints related to claims issues.
  • Review monthly denied claims reports and provide analysis to provider relations program manager.
  • Complete special research projects.
  • Analyze regular reporting by the MCOs.
  • Perform other tasks as directed.


REQUIRED QUALIFICATIONS

  • Bachelor Degree, or 6 years of professional experience in lieu of degree.
  • Experience working in a medical provider’s office or hospital setting for at least 5 years in the billing or coding department.
  • Extensive knowledge of provider claims submittal requirements, posting payments, recoupments and denials.
  • Extensive background working insurance company denials to investigate edits, database, coding and other errors.
  • Experience working directly with patients to resolve patient billing complaints, and knowledge of HIPAA guidelines and regulations.
  • Excellent analytical skills, effective organizational and time management skills.
  • Comfortable working in fast paced environment. Works well both independently and as part of a team.
  • Highly self-motivated.
  • Able to independently initiate communication with stakeholders.


DESIRED QUALIFICATIONS

  • Bachelor Degree in Public Health, Community Health or Healthcare Management.
  • Certified medical coder through AHIMA or AAPC.
  • 10 years of healthcare related experience.
  • Professional experience in Medicaid program support.
  • Professional experience working with insurance or Medicare.
  • Experience in writing policy.
  • Experience in reporting and statistical analysis.
  • Proficient in MS Office.


SALARY

Commensurate with qualifications and experience.


DATE POSTED

11/10/2017


CLOSING DATE


POSITION NUMBER

0296

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