West Texas Centers is seeking a highly motivated and detail-oriented individual to join our team as a Reimbursement Specialist!

Position Incentives and Benefits

We offer a rewarding work environment with opportunities including:

• Comprehensive health insurance
• Paid holidays
• Generous paid time off
• Employee Assistance Program
• Additional employee benefits

Position Summary

Under the supervision of the Director of Reimbursement, the Reimbursement Specialist is responsible for billing, payment posting, claims follow-up, and reimbursement reporting for Medicaid services, private insurance, and private-pay accounts.

This position ensures billing accuracy, monitors outstanding claims, identifies and resolves billing discrepancies, and reports adjustments and write-offs. Additional responsibilities include assisting with special projects assigned by the Chief Financial Officer (CFO), participating in designated committees, and working collaboratively with the Administrative Support Specialist to resolve credentialing issues that may result in claim denials.

This position may require travel throughout the local service area. Applicants must meet West Texas Centers' driving qualifications and have access to a personal vehicle. The position is based in Howard County.

Starting Salary: $19.38

Essential Duties and Responsibilities

1. Medicaid Billing

• Prepare and submit accurate Medicaid claims for TCM, therapies, service coordination, rehabilitation, and card services.
• Verify provider numbers before submitting claims.
• Provide weekly reports of providers not listed in the system to the Deputy CFO.
• Ensure all services are submitted for reimbursement at least monthly, according to source documentation.
• Review and correct electronic rejection reports.
• Conduct billing audits to ensure regulatory compliance.
• Report outstanding or problematic billing issues to the Deputy CFO and CFO.
• Maintain an assigned backup employee's knowledge of billing procedures and system changes, providing updates and training at least quarterly.
• Process and submit recoupment payments in accordance with agency procedures.

2. CHIP Billing

• Ensure billing information is accurate and complete.
• Submit claims for services according to source documentation at least monthly.
• Conduct compliance audits and report outstanding or problematic billing issues.
• Prepare and distribute monthly reports to the appropriate personnel.

3. Payment Posting

• Post Medicaid, CHIP, and private-pay payments by the fifth of the following month.
• Prepare and distribute payment reports as requested.

4. Claims Tracking and Follow-Up

• Monitor and track Medicaid, CHIP, and private-pay claims.
• Investigate outstanding claims and follow up on unpaid balances within established time frames.
• Contact payers by phone or electronically when payments have not been received within the required follow-up period.

5. Reporting and System Responsibilities

• Complete required data entries and generate all necessary Anasazi reports.
• Ensure reports are completed and distributed within established deadlines.
• Prepare monthly, quarterly, annual, and special reports as requested.

6. Auditing and Compliance

• Complete assigned audits within established time frames.
• Conduct audits using approved criteria and procedures.
• Forward audit findings and results to the appropriate personnel.

7. Policies and Procedures

• Assist with developing, reviewing, completing, and distributing departmental policies and procedures.
• Collaborate with appropriate staff during policy development.
• Ensure policies and procedures comply with Medicaid requirements, Performance Contract standards, and other applicable regulations.