Nineteen Services, Inc

Our company serves and supports a very diverse group of over 150 Medicaid service providers across Ohio. Each provider partner, although governed by the same set of rules in the Ohio Revised Code, may require the team to provide tailored and unique processes to meet their goals. We serve small, medium and large provider partners. Each provider partner comes with a different experience level and unique background.The Provider Support Specialist- Billing (PSSB) team is critical to the success of the provider partners we work with. It is our responsibility to stay up to date on legislative changes and consult with the provider partner on changes which impact their Medicaid services and billing. The role of PSSB team member is entry level and this role is critical to the success of the organization and the provider partners served. Building relationships, timeliness and accuracy is the foundation of this position.

Claims Processing – Dedicated provider support specialist to provider partners in the processing of Medicaid claims to the Ohio Department of Developmental Disabilities. o Process provider partners Medicaid claims at a frequency determined by the provider partner.o Track and report back to provider partner the utilization of authorized services.o Track and reconcile claims outcome and report back payment information to provider partner.o Serve as liaison between provider partner and authorizing authority. (local county board of developmental disabilities)o Research and resolve unpaid claims and reprocess in a timely fashion.o Audit billing information to ensure billing accuracy and compliance with federal Title XIX programs.Team Resources – Participate in bi-weekly and monthly update meetings. Update shared team tracking workbooks to show metrics and billing outcomes.o Maintain weekly/monthly provider partner tracking workbook and payment breakdowns.o Provide supervisor with the following data: outcome of monthly rate calculator homes. outcome of monthly tracking data regarding utilization and authorization metrics. status of denied claims and resolution attempts with notes. payment breakdown anomalies and resolution.Technical Training & Expertise – Manage your training plan and training opportunities provided. Review your training plan with your supervisor on a monthly basis to ensure that training aligns with provider partner needs, legislative changes and overall requirements for the position.

Skillbridge Eligible