The Billing and Patient Care Specialist for US Programs leads and performs activities related to Medicaid billing for US Programs, including payor contract management, claims and encounter submission, and accounts receivable. This position is responsible for maintaining policies and procedures defined by the Dental Director, training staff in coding and for identifying and implementing operational improvements. This position is also responsible for periodic and special clinic patient scheduling and serves as the internal first point of contact for patients calling with questions. The Specialist works closely with the Dental Director to ensure compliance with all federal and state regulations related to Medicaid and other healthcare regulations.
Medical Teams International Calling: Daring to love like Jesus, we boldly break barriers to health and restore wholeness in a hurting world.
- Submit bills, calculate reimbursements, and process payments and credits to ensure accurate revenue cycle accounting that comply with all Medicaid regulations, rules, and laws, and with any applicable third-party payor contracts.
- Develop, maintain, and monitor metrics related to billing, receivables, and collections, including payor denial and underpayment; take action as needed when problems arise. Monitor and report on all write offs.
- Evaluate and implement modifications to existing processes, systems and procedures to maximize timely collection of accounts receivable.
- Maintain and enhance expertise related to Medicaid coding and billing practices and software through continuing education.
- Ensure and participate in regular coding and billing audits are performed; take action as indicated, including improvements to processes and systems as well as additional focused training.
- Develop and deliver training to US Programs staff to ensure compliance issues are met regarding coding and billing practices
- Participate in ongoing Medicaid training as Medicaid rules are updated.
- Monitor coding and billing policies and procedures, in coordination with Business Manager and Dental Director.
Patient Point of Contact
- Serve as a point of contact for patients seeking to find a clinic, needing referral to additional treatment (such as a root canal or oral surgery clinic) or for questions about treatment, referrals etc.
- Refer patients to appropriate staff, partner or volunteer for follow-up or to further answer questions or concerns.
- Utilize electronic health record system to chart issues and referrals.
Medicaid Contract Administration
- Provide technical advice and knowledge to Executive Director, Dental Director, Business Services Manager and others within the organization related to any payor contracts into which US Programs may enter. Work with leadership and contract staff in evaluating contract language, terms, and requirements.
- Provide leadership and direction for contract management activities. Oversee and facilitate management, contracting, operations, communications, reporting, and data exchange for the contracting process in support of US Programs business objectives.
- Cultivate strong business relationships with the Medicaid payor and provider community.
- Provide oversight for the development and maintenance of contract policies, procedures, structures and training to support the staff and department into the future.
- Provide technical advice and knowledge to Executive Director and others within the organization related to the financial dimensions of Medicaid.
- Develop and maintain a reliable cash flow projection process and reporting mechanism, as well as financial models to support the US Programs contracting, budgeting, and forecasting process.
- Participate with US Programs leadership as it works to develop new revenue streams, identify new funding opportunities, and determine the cost effectiveness of prospective new services.
- Evaluate and advise US Programs leadership regarding the impact of potential changes to its business, including planned growth in volumes, the introduction of new programs, treatments or strategies, and regulatory actions.
- Provide Medicaid revenue forecasts and recommended staffing changes associated with potential changes.
- In collaboration with the Medical Teams finance department:
- Oversee and review Medicaid transactions for completeness and proper reporting.
- Prepare periodic financial and revenue cycle reports and updates.
- Work to resolve financial management and budgetary issues, including Medicaid revenue variances.
- Provide input into the budget as to Medicaid costs.
- Support safeguarding of program participants and employees through promoting an environment of awareness and upholding the code of conduct provisions of Medical Teams Protection from Sexual Exploitation & Abuse, Child & Vulnerable Adult protection, and harassment-free workplace policies.
- Utilize volunteers when appropriate.
- Additional duties as assigned.
EDUCATION, LICENSES, & CERTIFICATIONS REQUIRED:
- Associate’s degree or equivalent experience in related field.
- Bachelor’s degree in Business, Health Care Administration, or related field.
- Certificate in medical billing.
- Minimum 3 years’ experience in medical/dental billing (including Medicaid), provider relations, delivery system revenue cycle management, and/or network development.
- Minimum 5 years’ experience in medical/dental billing (including Medicaid), provider relations, delivery system revenue cycle management, and/or network development.
- Customer service experience.
- Patient scheduling experience.
KNOWLEDGE, SKILLS, & ABILITIES
- Commitment to Medical Teams International Calling Statement and Core Values.
- Strong understanding of Medicaid provider contracting, billing, and revenue cycles.
- Strong verbal and written communication skills, including the ability to present effectively to external and internal stakeholders.
- Solid business and financial acumen.
- Skilled at monitoring budgets and making appropriate adjustments as necessary.
- Skilled at attention to detail and managing projects to satisfactory completion.
- Highly skilled in electronic health record systems.
- Proficient with Office 365 suite, with special emphasis on spreadsheets.
- Creative Problem solver.
- Ability to work both independently and collaboratively across the organization.
- Ability to plan, prioritize, and coordinate multiple projects or tasks.
- Ability to train and keep staff updated regarding treatment codes.
- Ability to work cooperatively in a team environment.
- Ability to prioritize tasks.
- Ability to embrace and promote Medical Teams’ Calling and Core Values.
- Ability to represent the organization in a professional manner to partners, volunteers, and the public.
PHYSICAL REQUIREMENTS & WORKING CONDITIONS
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job the employee must be able to:
- Frequent use of a personal computer, database and digital platforms, and other office productivity machinery, such as a copy machine and computer printer.
- Frequently uses hands, fingers, and arms to reach, handle, touch or feel equipment, medical instruments, materials, computer.
- Frequent communication and exchange of information among colleagues and persons of concern which requires the ability to speak, hear, convey and express oneself.
- Frequent close vision and the ability to adjust focus.
- Occasionally ascends/descends stairs, steps, or ladder.
- Occasionally move about inside an office to access file cabinets, office machinery, meet with colleagues, etc.
- The employee must occasionally lift and/or move up to 10 pounds.
- Seldom to occasionally positions self to stoop, kneel, crouch, or crawl.
- The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- The noise level in the work environment is usually moderately quiet.
- The employee may be required to travel to remote areas of the world where there are potential health hazards and risks, limited hygiene facilities, extreme hot or cold weather, and very basic living conditions.