NaphCare has an excellent opportunity for a Medicaid Reimbursement Specialist to join our Corporate Headquarters in Birmingham, AL.
The Medicaid Reimbursement Specialist will research and interpret regulatory payment policies and claims processing guidelines for multiple Medicaid states.
The ideal candidate will have a strong knowledge and previous experience of CPT, ICD-10, HCPCS, Code Modifiers as assigned by the Centers for Medicare and Medicaid Services (CMS).
NaphCare partners with correctional facilities to provide proactive, patient-focused healthcare.
We recognize that we serve a unique and diverse patient population, and our onsite teams take pride in bringing excellence in care to a population in great need.
Be part of a world-class team of professionals who are revolutionizing correctional healthcare.
Responsibilities:Perform data analysis tasks, which include extracting fee schedules, provider files, base rates and edits using software programs such as Microsoft Excel.
Assist in maintaining fee schedules and data in all systems.
Liaison with third party pricing and editing vendors (i.e.
3M, Payer Compass, Optum).
Educating internal staff regarding payment systems and procedures.Analyze claims pre and post processing to ensure Medicaid rates and edits are applied accurately.
Assist in reviewing provider appeals to determine if claims paid accurately.
Requirements:Bachelor’s degree or equivalent combination of education and applicable job experience.
Minimum of three years of experience with Medicaid billing, claims processing and reimbursement.
Experience with multiple Medicaid states and provider types (i.e.
hospital, professional, ambulance, DME, clinical lab, etc.) preferred.Experience with working in claims payment systems; with multiple pricing and editing software (i.e.
3M, Payer Compass, Optum programs, etc.) preferred.Experience with Medicare billing and reimbursement; both Part A and Part B a plus.
CPC certification a plus.This is not a remote position.Equal Opportunity Employer: disability/veteranOutstanding Benefits Package:NaphCare offers competitive benefits, including health, prescription, dental, Employment Assistance Program (EAP) services, vision and 401(k).
NaphCare offers term life insurance at no cost to the employee and provides PTO, paid holidays and an array of voluntary benefits.
Employees enrolled in our health insurance program receive prescriptions free of charge when filled at our in-house pharmacy or mail order program.