Medicaid / Manage Care Resource

Medicaid / Managed Care Resource

The Medicaid / Managed Care Resource is responsible for coordinating all aspects of the monthly billing cycle for Medicaid / Managed Care revenue. This position manages a high volume of claims and must work quickly and efficiently to manage the consistent flow of work. Other relevant duties as may be assigned by the AR Market Leader or designee.

Essential Functions and Responsibilities :

• Ensures CAPLICO Core Values and Code of Conduct are adhered to at all times.
• Ensures compliance with Resident Rights and HIPAA policies at all times.
• Monitors eligibility and authorizations to assure appropriate steps have been completed to submit clean claims.
• Ensures the proper demographics and diagnosis codes are entered into PCC for billing purposes.
• Responsible for setting up the AR Insurance Tab according to payer guidelines.
• Generates and submits Medicaid claims through Waystar or third-party portal.
• Completes all payer rejections in a timely manner in accordance with contract guidelines.
• Submits appeals and reconsiderations.
• Meets billing compliance standards.
• Identifies and communicates possible system and reimbursement problems to facilitate an efficient and accurate review of the payers.
• Review billing reports to identify areas that may need attention.
• Assists and covers other staff when necessary to maintain productivity and efficiency in the department.
• Processes refunds and write offs.
• Performs PCC Month End Close and uploads all documents to the Month End Close Application.
• May perform other duties as assigned.

Supervisory Responsibility :

Working Conditions :

Physical Demands and Sensory Requirements (With or Without the Aid of Mechanical Devices) :

Specific Requirements :

Minimum Qualifications :

The employer for this position is The Pennant Group, Inc., a holding company of independent operating subsidiaries that provide healthcare services through home health and hospice agencies and senior living communities located throughout the US.