LTC Medicaid Billing Specialist

Insurance Healthcare Company; Chicago (IL); On-site; USD 55,000 - 75,000; Full time

Job summary

Insurance Healthcare Company in Illinois is seeking an experienced LTC Medicaid Billing Specialist to manage long-term care and skilled nursing resident Medicaid billing. You will process MEDI-based adjustments, investigate discrepancies, and collaborate with facility staff to ensure accurate resident accounts.

The ideal candidate has 3+ years of medical billing experience, direct LTC Medicaid exposure, and hands-on use of MEDI, ABE, RFMS, and PCC to drive timely reimbursements.

Qualifications

• 3+ years of medical billing experience.
• Direct experience with Long-Term Care Medicaid billing.
• Hands-on experience with Illinois Medicaid.
• Experience making income adjustments through MEDI.
• Experience with ABE, RFMS, PCC.

Responsibilities

• Manage and maintain Medicaid billing for long-term care and skilled nursing residents.
• Process Medicaid billing adjustments, corrections, and account changes.
• Make and manage resident income adjustments through the Illinois MEDI system/portal.
• Work with ABE, RFMS, and PCC as part of the Medicaid billing process.
• Research and resolve Medicaid billing discrepancies, rejections, and payment issues.
• Review resident accounts for missing or incorrect income information.
• Identify and correct billing issues impacting Medicaid reimbursement.
• Follow up on outstanding Medicaid balances
• Maintain accurate documentation of billing activity and adjustments
• Communicate with facility personnel to resolve account issues
• Assist with Medicaid eligibility and resident financial issues
• Manage multiple accounts while ensuring accuracy and deadlines

Skills

LTC Medicaid billing

Illinois Medicaid

MEDI system

income adjustments

resident accounts

discrepancy research

Tools

ABE

RFMS

PCC

Job description

LTC Medicaid Billing Specialist

Healthcare Organization | Illinois

We are seeking an experienced Long-Term Care (LTC) Medicaid Billing Specialist with strong hands-on experience in Illinois Medicaid billing, the MEDI system, and income adjustments.

This is a specialized position for an experienced professional who understands the unique billing and financial requirements associated with skilled nursing facilities and long-term care residents.

If you have worked directly with MEDI, ABE, RFMS, and PCC and know how to research and process resident income adjustments, we want to hear from you.

What You'll Do

• Manage and maintain Medicaid billing for long-term care and skilled nursing residents

• Process Medicaid billing adjustments, corrections, and account changes

• Make and manage resident income adjustments through the Illinois MEDI system/portal

• Work with ABE, RFMS, and PCC as part of the Medicaid billing and resident account process

• Research and resolve Medicaid billing discrepancies, rejections, and payment issues

• Review resident accounts for incorrect or missing income information

• Identify and correct billing issues that impact Medicaid reimbursement

• Follow up on outstanding Medicaid balances and unresolved accounts

• Maintain accurate documentation of billing activity and adjustments

• Communicate with facility personnel and other parties to obtain information needed to resolve account issues

• Assist with Medicaid eligibility and resident financial issues related to billing

• Manage multiple accounts while maintaining accuracy and meeting deadlines

Required Experience

• 3+ years of medical billing experience, preferably in long-term care/skilled nursing

• Direct experience with Long-Term Care Medicaid billing

• Hands-on experience with Illinois Medicaid

• Experience making income adjustments through MEDI

• Experience working with ABE, RFMS, and PCC

• Strong understanding of Medicaid billing in a skilled nursing/long-term care environment

• Experience researching and resolving Medicaid billing discrepancies

• Strong attention to detail and accuracy

• Ability to work independently and manage multiple accounts

Highly Preferred

• Experience working with multiple skilled nursing or long-term care facilities

• Experience with Medicaid eligibility and redeterminations

• Experience with resident income changes and financial adjustments

• Knowledge of Illinois LTC Medicaid processes

• Experience with Medicaid denials, corrections, claims, and reimbursement

• Experience working with facility business offices or resident accounts

Who Will Succeed in This Role?

We're looking for someone who already knows LTC Medicaid billing.

You should be comfortable getting into a complicated resident account, identifying the issue, navigating the appropriate Medicaid systems, making the necessary adjustment, and following the account through to resolution.

This is not an entry-level medical billing position. The strongest candidates will have direct, recent experience with Illinois LTC Medicaid, MEDI, ABE, RFMS, PCC, and income adjustments.

What We Offer

• Competitive compensation based on experience

• Opportunity to work in a specialized healthcare billing environment

• Stable, professional work environment

• Opportunity to utilize and further develop your LTC Medicaid expertise