• Medicaid Claims Specialist - OOS

    Location US-UT-Draper
    Job ID
    Out Of State
  • About The Company

    MedData, a MEDNAX (NYSE: MD) company, is a technology-enabled services organization that improves financial outcomes for hospitals by enhancing the patient experience and expanding their access to healthcare. The MedData managed services program includes a range of patient access and communications, revenue cycle management, and consulting and analytics solutions for healthcare systems, including billing, coding, patient balances, eligibility and enrollment, third party liability, and mobile apps.
    At MedData, we take great pride in our company, in each other, and in our 30+ year history of accomplishments and success. This pride is reflected in our everyday approach to working together. Each team member understands the importance of being part of a company that values their individual contributions and strives to help them achieve their personal goals as they work together to achieve the broader corporate goals. We believe that every team member contributes directly to MedData’s growth and success, and we are constantly searching for new talented, passionate and enthusiastic people who will take pride in being an integral part of our culture.

    Job Description

    MedData has an excellent career opportunity available as a Medicaid Claims Specialist - OOS to work in a regional office located in Draper, Utah. The schedule for this Full Time role is Monday - Friday 8am - 4:30pm.  




    MedData provides revenue cycle solutions to hospitals and physicians throughout the United States. This includes AR support for Out-of-State Medicaid accounts.  The purpose of this position is conduct Medicaid eligibility, authorization, billing and follow up functions.  




    1. Properly identify Medicaid eligibility, authorization, enrollment and documentation requirements for hospital and physician accounts. Training and software to assist with these functions will be provided.
    2. Submit authorization requests to Medicaid payers and perform appropriate follow up to ensure authorization requests are resolved in a timely manner.
    3. Perform manual data entry of patient accounts and or claim forms.
    4. Obtain bills, medical records or other necessary documentation from medical providers in a timely manner.
    5. Review and edit claims to ensure they meet state and federal guidelines.
    6. Submit claims timely and accurately to Medicaid payers.
    7. Perform aggressive follow-up on unresolved claims.
    8. Facilitate timely payment from Medicaid payers.
    9. Research denials and/or underpayments and formulate appeal letters and/or disputes to Medicaid plans in accordance with state guidelines.
    10. Submit payment details to the cash posting team.
    11. Work in compliance with state and federal guidelines, including HIPAA and FDCPA.
    12. Maintain case clear, concise and accurate account notation.
    13. Monitor the status of accounts and communicate effectively with management, clients and other parties regarding the status of the accounts.
    14. Provide responses to client inquiries within 24 hours.
    15. Other duties as assigned.




    To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or abilities.


    • High School Diploma or GED.
    • Working knowledge of ICD9, CPT codes, HIPAA, HCPCS and Medicaid preferred.
    • 1-2 years of related experience in the healthcare industry or in a related area.
    • Excellent verbal and written communication skills.
    • Strong organizational skills.
    • Ability to multi-task.
    • Critical thinking and strong attention to detail.
    • Required computer skills: must have experience with data entry and word processing, be capable of operating routine office equipment, possess a working knowledge of MS Office applications, and understand how to navigate through multiple web-based applications. 




    The physical demands 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 is frequently required to sit; use hands to finger, handle, or feel; and reach with hands and arms.  The Employee is occasionally required to stand and walk and must occasionally lift and/or move up to 20 pounds. 


    The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or a logical assignment to the position.



    This job description is to serve as a guide but no way is it to be considered a comprehensive list of task, duties and responsibilities that will be required by the employee.


    To join our team of 2,000 employees and growing, please apply directly to this posting.


    MedData is an Equal Opportunity Employer



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