Medicaid Billing Specialist in Santa Ana, CA at Parallon

Date Posted: 8/5/2018

Job Snapshot

Job Description


The out of state Medicaid biller is responsible for the timely submission of hospital based service claims with various Medicaid payors.

Essential Duties and Responsibilities:

  • Understanding Coding and ICD criteria
  • Knowledge of basic Medicaid billing rules, regulations, and deadline
  • Submits insurance claims to individual insurance companies electronically or via paper form.
  • Prepares and submits clean claims to various Medicaid agencies and or assigned payers
  • Using coded data to produce and submit claims
  • Analyze remittance advice to ensure accurate posting of rejections, payments and contractual adjustments timely.
  • Reviewing and appealing unpaid and denied claims
  • Maintains a working knowledge of payer practices and reimbursement methodologies and becomes a subject matter expert in assigned A/R responsibilities.
  • Review UB/1500 claims for accuracy and completeness and obtain any missing information as needed for submission
  • Knowledge of out of state Medicaid billing guidelines
  • Check each insurance payment for accuracy and compliance with contract discount
  • Identify and bill secondary or tertiary insurances
  • Ability to look up ICD 9 diagnosis and CPT treatment codes from online service or using traditional coding references.
  • Understanding of Remittance Advise details for Medicaid
  • Other duties as needed.
    • Working directly with the Medicaid agency to get the claim processed and paid.


Job Requirements


  • Minimum 2 years of experience in a medical office or healthcare business office; or equivalent combination of education and experience.
  • Working experience with all payer types including: commercial, governmental, Medicare, Medicaid, HMO, etc. and the ability to cross-over into different payers.
  • Established experience using Microsoft Excel, Microsoft Word and Microsoft Outlook is required.
  • Must have excellent verbal and written communication skills.
  • Understanding of co-pay, coinsurance, and deductibles and intermediate to expert experience in electronic claim submission and edit resolutions, third party payer insurance verification, collections and denial resolution process.
  • Medical Billing & Coding degree and/or Certification required.

Skills or Other Qualifications Required:


•                      Excellent written and oral communication skills

•                      Extreme attention to detail and accuracy.

•                      Strong customer service skills required.

•                      General business office knowledge.

•                      Analytical ability a plus.

•                      Must be organized and the ability to work well under pressure.

•                      Meet multiple and competing deadlines.

•                      The ability to type 45-55 WPM

•                      Ability to manage 10-key