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Position Title:
Department:
Reports To:
Medicaid Specialist
Operations
Assistant Director
Summary of Job Description:
Performs effective collection functions on Medicaid outstanding receivables in accordance with
established Citadel Outsource Group policies and procedures.
Duties and Responsibilities:
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Provides customer service to patients concerning outstanding account balances.
Researches account error(s) and corrects the discrepancies.
Works assigned aged trial balance (ATB) on a daily basis.
Ensures that high dollar accounts are worked on a weekly basis.
Works all rejected and error claims in the State specific Medicaid on-line system on a daily
basis.
Follows state Medicaid requirements as they will vary by state.
Ensures that all accounts are worked thoroughly, completely, assertively, timely and
brought to closure appropriately.
Notifies Citadel Outsource Group Compliance Officer when Compliance concerns are
identified.
Follows Citadel Outsource Group follow-up time frames.
Ensures that voice mail messages are returned within twenty-four (24) hours.
Verifies insurance information (Insurance Verification Form-OPSF-13c) when provided by
the patient/guarantor utilizing Internet based resources, Medifax, Passport and/or client
information system.
Initiates the completion of client specific Denial Log (OPSF-17a) and forwards to the
assigned Managed Care Specialist on a daily basis.
Uses sound judgment in requesting Medical Records contents from the client.
Resolves account denials (i.e. non-covered, overlaps, spend-downs, provider number
issues, etc.) by taking the appropriate resolution action.
Resolves account credit balances by taking the appropriate resolution action.
Follows HIPAA guidelines and standards when communicating minimal patient clinical
information to payor(s) for assistance in resolving denials.
Researches the client information system to ensure that all pertinent information needed
for claims adjudication is communicated appropriately to the payor(s) and/or physician’s
office.
Resolves account rebilling and secondary billing requests by completing the rebilling and
secondary billing actions (i.e. printing the claim form, retrieving needed attachments,
placing documents in envelopes, etc.).
Prepares Medicaid credit balance reports (if applicable) timely, accurately, and
following Medicaid guidelines in the credit balance/overpayment determination.
Notifies Management of trends found during the account resolution process including,
but not limited to, credit balance issues, CPT/HCPCS errors/deletions, duplicate claims,
revenue code mapping mismatches, missing charges, no claim on file, etc.).
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Performs necessary follow up for additional information needed including patient contact
as needed.
Documents any account activity, actions and contacts in the client information system at
the time of the action taken.
Completes internal and external forms accurately, legibly, and in a timely manner
Utilizes Citadel Outsource Group Resource Center and Operations policies and
procedures to ensure the proper course of action.
Consistently meets the minimum Citadel Outsource Group productivity standard.
Assists with special projects as needed.
Notifies Management of on-line resources as determined to ensure access is obtained
appropriately.
Notifies Management of phone numbers that are routinely utilized for insertion into the
speed dial directory of the telephone system.
Accepts and supports change in Citadel Outsource Group policies.
Performs other duties as assigned.
Job Requirements:
Education and Training
 High School Diploma or GED equivalent
Experience
 Previous Healthcare Insurance Collections, Preferably State Medicaid Programs
Physical
 Manual dexterity
 Finger dexterity
 Hear alarms, telephone and pages
 Walking up to one (1) hour per day
 Sitting up to seven (7) hours per day
 Reaching above shoulder
 Repetitive arm and hand movements
 Lifting, carrying, pushing, and pulling up to thirty (30) pounds
 Acuity far and near
Equipment
 Computer
 10-key calculator
 Fax machine
 Telephone
 Copy machine
 Electronic communication tools
 Time Clock and Attendance system
 Medifax and Passport applications
 Internet
 Client Information System
 State Specific Medicaid Claims Status/Verification/Eligibility Software
Approval:
Human Resources: _______________________________________ Date: ___________________
VP of Operations: ________________________________________ Date: ___________________