You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.
Job Summary
Our client is seeking a skilled Patient Account Representative to manage full-cycle Medicaid billing and claim submission, ensuring accurate claim generation, review, and submission for hospital and RHC encounters.
Key Responsibilities
- Manage full-cycle Medicaid fee-for-service and Medicaid Managed Care (MCO) billing.
- Generate, review, and scrub daily claims for hospital encounters (inpatient/outpatient) and RHC encounters, ensuring correct encounter codes and primary/secondary payer sequencing.
- Review, correct, and validate claims within the SSI clearinghouse daily between 11:00 AM and 3:00 PM, resolving front-end payer rejections prior to the final 3:00 PM transmission.
- Verify member eligibility, managed care plan enrollment, and carve-out coverage (such as behavioral health or specialty pharmaceuticals) through state Medicaid web portals (e.g., ProviderOne for WA) and MCO portals.
Experience
- Proven experience handling both front-end claim submission and back-end edit/denial resolutions.
Skills
- Cerner EMR: Hands-on experience working in Cerner software queues.
- Method 2 Billing Knowledge: Direct experience with Method 2 billing rules for Critical Access Hospitals and Rural Health Clinics (RHC)—a critical requirement due to strict billing guideline differences from Method 1.
- Payer Experience: Strong background working with Medicaid and managed care insurance payers.
- Washington State Billing Rules: Familiarity with Washington-specific regulations, such as state vaccine billing guidelines.
Additional Requirements
- Standard shift from 6:30 AM to 3:00 PM, totaling 40 hours per week.
Benefits
- Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
- Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
- 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
- Short Term Disability Insurance.
- Term Life Insurance Plan.
*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).
Medix Overview:
With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.
Any required state or Joint Commission training is compensated at the state or local minimum wage rate.
*As a job position within our Revenue Cycle division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, handling financial and other payment data, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.
