Medicaid Billing Associate - Hybrid

Job Title: Medicaid Billing Associate-Hybrid
Work Location: Oklahoma City
Division/Department: PMBS

The position is responsible for the billing, follow-up, collection, and resolution of ambulance claims submitted to Medicaid payers. This position works accounts across Oklahoma, Arkansas, Mississippi, Louisiana, and Texas and is responsible for ensuring claims are processed accurately, followed up timely, and resolved in accordance with payer requirements and company policies.

They manage assigned accounts from initial claim submission through final payment or appropriate resolution. This includes reviewing claim status, working denials and rejections, submitting corrected claims and appeals, identifying coordination-of-benefits issues, reviewing payments and underpayments, and communicating with insurance carriers and patients when additional information is required.

Essential Duties and Responsibilities

• Bill and follow up on Medicaid ambulance claims for assigned states and payers.
• Review claims for accuracy and completeness prior to and following submission.
• Verify appropriate payer, member information, claim filing requirements, and billing information.
• Monitor electronic and paper claims to ensure successful submission and payer acceptance.
• Identify and correct rejected claims in a timely manner.
• Submit corrected claims, reconsiderations, and appeals when appropriate.
• Follow payer-specific billing requirements for ambulance services.
• Maintain knowledge of Medicaid billing requirements applicable to assigned states.

        Accounts Receivable Follow-Up

• Work assigned accounts receivable inventories consistently and within established follow-up timeframes.
• Review payer portals, electronic claim status, remittance information, and other available resources to determine claim status.
• Contact insurance carriers when additional information is required to resolve outstanding claims.
• Identify claims that have not processed within expected payer timeframes and initiate appropriate follow-up.
• Prioritize aged, high-dollar, and timely-filing-sensitive accounts.
• Take appropriate action on each account rather than repeatedly documenting status without moving the account toward resolution.
• Maintain accurate and complete documentation of all account activity.

        Denials & Rejections

• Review and resolve Medicaid claim denials and rejections.
• Identify the underlying reason for denial and determine the appropriate corrective action.
• Correct billing or claim information when appropriate.
• Submit reconsiderations or appeals with supporting documentation when warranted.
• Identify recurring denial trends and communicate potential process or documentation issues to leadership.
• Monitor appealed or corrected claims through final resolution.
• Ensure denials are addressed within payer appeal and timely-filing deadlines.

        Medicaid

• Maintain working knowledge of Medicaid billing requirements for Oklahoma, Arkansas, Mississippi, Louisiana, and Texas.
• Understand state-specific Medicaid requirements and managed Medicaid payer requirements applicable to ambulance services.
• Review eligibility and managed-care enrollment when necessary to determine the appropriate payer.
• Address authorization, medical necessity, documentation, eligibility, and other Medicaid-related denials.
• Follow state Medicaid and managed-care requirements for corrected claims, reconsiderations, and appeals.
• Monitor changes in Medicaid billing requirements and escalate identified changes to leadership.

        Payment & Remittance Review

• Review Explanation of Benefits (EOB) and Electronic Remittance Advice (ERA) information to determine appropriate next action.
• Identify denials, underpayments, non-covered services, coordination-of-benefits issues, and other payment discrepancies.
• Ensure contractual adjustments and patient responsibility are appropriate before account resolution.
• Identify inappropriate payer reductions or processing issues and initiate follow-up when necessary.
• Escalate suspected payer trends, systemic underpayments, or recurring processing problems.

        Patient Responsibility & Coordination of Benefits

• Determine when balances should appropriately be transferred to patient responsibility.
• Request updated insurance or coordination-of-benefits information when necessary.
• Ensure all appropriate insurance billing options have been addressed before transferring balances to the patient.
• Follow company policy regarding patient billing and account resolution.

        Documentation & Account Management

• Document all payer contacts, portal research, claim status, denial information, appeals, corrected claims, and account actions clearly and accurately.
• Maintain sufficient documentation to allow another team member or auditor to understand the history and current status of the account.
• Work accounts according to established productivity and quality expectations.
• Meet established deadlines for timely filing, corrected claims, reconsiderations, and appeals.
• Escalate unresolved or unusual accounts to leadership when appropriate.

Minimum Qualifications

• Knowledge of medical billing and accounts receivable processes.
• Knowledge of Commercial insurance and Medicaid billing preferred.
• Ambulance or EMS billing experience strongly preferred.
• Ability to read and interpret EOBs, ERAs, payer correspondence, claim status information, and denial codes.
• Understanding of electronic claim submission, corrected claims, appeals, coordination of benefits, and timely filing.
• Strong analytical and problem-solving skills.
• Strong attention to detail and account documentation.
• Ability to manage a high-volume account inventory.
• Ability to prioritize accounts based on aging, dollar amount, filing deadlines, and payer requirements.
• Strong written and verbal communication skills.
• Ability to work independently while appropriately escalating complex issues.
• Proficiency with billing systems, payer portals, and Microsoft Office applications.

Education & Additional Requirements

• High school diploma or equivalent required.
• Medical billing, insurance follow-up, accounts receivable, or related healthcare experience preferred.
• Must have access to high-speed internet-at least 20mbps download, and must be hardwired
• In person and hybrid in the Oklahoma City area-Will be in the office minimum 3 times a week.

Physical Requirements

• Ability to safely and successfully perform the essential job functions consistent with the ADA, FMLA and other federal, state and local standards, including meeting qualitative and/or quantitative productivity standards.
• Ability to maintain regular, punctual attendance consistent with the ADA, FMLA and other federal, state and local standards.
• The employee may occasionally be required to lift and/or move up to 20 pounds
• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
• Work may require sitting, lifting, stooping, bending, stretching, walking, standing, pushing, pulling, reaching, and other physical exertion.
• Must be able to talk, listen and speak clearly on telephone.
• Must possess visual acuity to prepare and analyze data and figures, operate a computer terminal, and operate a motor vehicle.

Travel Time

• Negligible

NOTE: The above statements are intended to describe the general nature and level of work being performed by the person assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties, skills and physical demands required of personnel so classified.