Medcicaid Billing,Authorization & Compliance Specialist

2nd Home Skilled Care Services LLC; Aurora (CO); On-site; USD 55,000 - 65,000; Full time

Job summary

2nd Home Skilled Care Services LLC in Aurora, CO is seeking a Medicaid Billing Specialist to manage claims, authorizations, and related documentation. You will verify eligibility, monitor authorizations, and coordinate with clinical and administrative teams to ensure accurate billing and regulatory compliance.

The role requires experience with Medicaid billing, EVV systems, and CHAP readiness, with a focus on accuracy, timeliness, and cross-department collaboration in a fast-paced home health

Qualifications

• Experience in Medicaid billing and healthcare administration.
• Knowledge of insurance eligibility verification, claims processing and authorizations.
• Strong organizational skills and excellent attention to detail.
• Proficiency with Microsoft Office, especially Excel.
• Ability to manage multiple responsibilities and meet deadlines.
• Excellent written and verbal communication across departments.
• Colorado Medicaid familiarity is preferred.

Responsibilities

• Prepare, review, and submit Medicaid claims accurately and on time.
• Monitor payments, denials, rejections, and balances.
• Investigate and resolve billing discrepancies and claim issues.
• Reconcile payments and maintain billing records.
• Ensure compliance with Medicaid requirements and authorizations.
• Follow up on unpaid claims and coordination with teams.
• Verify eligibility, authorizations, and EVV records.
• Maintain CHAP survey readiness documentation and records.

Skills

Medicaid billing

Healthcare administration

Insurance eligibility verification

Prior authorizations

Attention to detail

Multitasking

Communication skills

Tools

Excel

Axxess

Sandata

SimiTree

EVV systems

Monday.com

Job description

• Location 3131 S Vaughn Way,Ste 600,Aurora, CO, 80014,United States
• Base Pay $55,000.00 - $65,000.00 / Year
• Employee Type W2

Key Responsibilities

Prepare, review, and submit Medicaid claims accurately and within required deadlines.

Monitor claim payments, denials, rejections, and outstanding balances.

Investigate and resolve billing discrepancies and claim issues.

Reconcile payments and maintain accurate billing records.

Ensure all billed services comply with Medicaid requirements, approved authorizations, and applicable regulations.

Follow up on unpaid claims and outstanding balances.

Work closely with the clinical and administrative teams to resolve billing concerns.

Authorization & Scheduling Coordination

Verify Medicaid eligibility, insurance coverage, and service authorizations.

Track Prior Authorization Requests (PARs), approval statuses, expiration dates, and authorized service units.

Monitor upcoming authorization expirations and initiate timely follow-ups.

Communicate approved authorizations and service changes to the scheduling team.

Coordinate with the Skilled Nursing Team to ensure scheduled services align with approved authorizations.

Identify missing authorizations, scheduling discrepancies, and potential billing concerns.

Communicate with case managers, Medicaid representatives, and internal staff regarding authorization issues.

Review and reconcile daily attendance, visit records, and service documentation.

Verify that billed services accurately reflect services provided.

Monitor Electronic Visit Verification (EVV) records for accuracy and completeness.

Identify missing documentation, incorrect billing units, and visit discrepancies.

Coordinate with clinical staff to resolve documentation concerns before claims are submitted.

Maintain accurate and organized records to support Medicaid billing and regulatory compliance.

CHAP Accreditation & Survey Readiness

Maintain ongoing readiness for CHAP accreditation surveys and regulatory inspections.

Organize, maintain, and regularly update CHAP survey readiness binders, both physical and electronic.

Ensure required policies, procedures, committee meeting minutes, logs, and compliance documentation are current and readily accessible.

Monitor survey readiness checklists and identify missing, incomplete, or outdated documentation.

Coordinate with the Director of Nursing, Administrator, and department managers to maintain compliance with applicable CHAP standards.

Assist with preparing documentation for initial, renewal, and unannounced surveys.

Support mock surveys, internal compliance reviews, and corrective action follow-ups.

Track identified deficiencies and assist with maintaining Plans of Improvement (PIPs) and supporting documentation.

Maintain organized records of quality assurance activities, audits, and regulatory compliance efforts.

Assist leadership with ensuring the agency remains survey-ready throughout the year.

Administrative & Reporting Responsibilities

Prepare and maintain billing, authorization, attendance, and compliance reports.

Monitor unbilled services, outstanding claims, and authorization discrepancies.

Assist with internal audits, billing reviews, and documentation requests.

Maintain accurate tracking systems and spreadsheets for billing and operational activities.

Collaborate with department managers to improve workflows, efficiency, and accountability.

Ensure timely communication between billing, scheduling, clinical, and administrative departments.

Maintain patient confidentiality and comply with HIPAA, Medicaid regulations, and agency policies.

Perform additional administrative and compliance-related duties as assigned.

Requirements

Required Qualifications

Previous experience in medical billing, Medicaid billing, or healthcare administration.

Knowledge of insurance eligibility verification, claims processing, and prior authorizations.

Strong organizational skills with excellent attention to detail.

Proficiency in Microsoft Office, particularly Excel.

Ability to manage multiple responsibilities, prioritize tasks, and meet deadlines.

Strong written and verbal communication skills.

Ability to work independently while collaborating effectively with multiple departments.

Experience maintaining accurate records, reports, and compliance documentation.

Ability to handle confidential patient and agency information professionally.

Preferred Qualifications

Experience with Colorado Medicaid (Health First Colorado).

Knowledge of Home and Community-Based Services (HCBS).

Experience with skilled nursing or home health billing.

Familiarity with Medicaid provider portals, EVV systems, and electronic health records.

Experience using Axxess, Sandata, and SimiTree.

Experience with Monday.com or similar workflow and tracking systems.

Knowledge of CHAP accreditation standards and home health regulatory requirements.

Experience preparing and maintaining CHAP survey binders and accreditation documentation.

Previous involvement in healthcare compliance audits, mock surveys, or survey preparation.

Familiarity with Quality Assurance and Performance Improvement (QAPI) processes.

Excellent time management and multitasking abilities.

Strong problem-solving and analytical skills.

Ability to identify discrepancies and proactively resolve issues.

High level of accuracy and attention to detail.

Professional communication and teamwork.

Ability to work efficiently in a fast-paced healthcare environment.

Strong sense of accountability and follow-through.

Commitment to maintaining regulatory compliance and operational efficiency.

Summary

This position is responsible for managing Medicaid billing and claims, verifying insurance eligibility, tracking service authorizations, coordinating scheduling information, maintaining accurate documentation, and supporting CHAP accreditation and survey readiness.

The ideal candidate will have experience with Colorado Medicaid (Health First Colorado), strong organizational and communication skills, and the ability to work collaboratively with multiple departments to ensure billing accuracy, regulatory compliance, and efficient daily operations.