Medicaid Billing Specialist

Under the direction of the Director of Revenue Cycle or designee, the Medicaid Billing Specialist ensures all traditional Medicaid and Medicaid Managed Care claims are reviewed for claim edits, claim submission, and timely follow up, as assigned.

Duties and Responsibilities :

• Review claims before submission for missing modifiers, charges, and / or implants
• Validate and make corrections on the UB04 resolving all claim edits before claim submission
• Validate pharmacy quantities are reflected on the claim correctly
• Validate claim against the coding abstract to ensure accurate billing of procedures
• Review 24 and 72-hour admission report combining claims, as needed
• Split inpatient claims as appropriate, per carrier guidelines
• Submit claims to carriers with the appropriate remarks and / or attachments
• Run insurance eligibility and correct claim before submission as needed
• Pull supporting documents for annual regulatory audits, as needed
• Ensure Medicaid credit balances are reviewed and resolved timely
• Other billing assignments, within skillsets and abilities

Education

High School graduate or equivalent

Experience

• Minimum 2-years Medicaid billing experience in an acute care facility
• Working knowledge of Common Procedural Terminology (CPT) and ICD10 Codes
• Working knowledge of Federal, State, and Commercial billing guidelines

Additional Information

Houston's oldest hospital is GROWING!

Welcome to St. Joseph Medical Center (SJMC), Houston's first and only downtown hospital delivering world-class care for the last 137 years and looking forward to the next century of exceptional care for Houstonians when they need us most.

Whether it's for a scheduled surgery, the birth of a baby, an unexpected emergency, or an outpatient visit, we have staff available around the clock to provide you with access to immediate, quality health care.

SJMC has been providing health care services to Greater Houston residents for over 130 years, which should give you great comfort in knowing that we have a great tradition of caring for our community.

We strive to meet our patients' expectations and encourage our patients to provide us with feedback on how we can help them have the best experience possible while they're in our care.

Over the last years, we have expanded our services to include the Advanced Wound Care Center, Comprehensive Cardiac and Vascular Services, the Women's Center, the St.

Joseph Maternal Fetal Medicine Center, and a Weight Loss Surgery Program, just to name a few. As you work with our physicians, nurses, case managers, educators, and other staff, you will be guided through your health care journey, from diagnosis to treatment, with compassion every step of the way.

Diversity, equity, inclusion, and belonging are at the foundation of the care St Joseph Medical Center provides to our community we are privileged to support in all of our employment practices.

We do not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or expression or any other non-job-related characteristic.