Medicaid A/R Denials & Payment Specialist

Saint Michael's Medical Center; Chicago (IL); On-site; USD 25,000 - 36,000; Full time

Job summary

Prime Healthcare Illinois Medical Group in Chicago is seeking an Account Resolution Specialist to ensure timely follow-up with managed care and government payers by phone, review payer contracts, and uphold productive billing operations.

You will work with revenue, coding and billing teams to resolve denials, prepare appeal letters, and monitor KPIs while ensuring compliance with Medicaid regulations and accurate patient financial records.

Qualifications

• Minimum of 4 years of experience in Medicaid billing and follow-up.
• In-depth knowledge of Medicaid regulations, coding, and billing procedures.
• Experience with Medicaid billing software and EHR systems, preferably Epic.
• Strong analytical and problem-solving abilities.
• Attention to detail and accuracy.
• Effective communication and interpersonal skills.
• Ability to work independently and manage multiple tasks.
• Proficiency in Microsoft Office Suite (Word, Excel)

Responsibilities

• Follow up on A/R to identify and resolve payer issues.
• Follow up on unpaid claims to work toward resolution and collection.
• Address and resolve denials using medical records and payer contracts.
• Compose and submit appeal letters.
• Identify and elevate denial patterns to leadership.
• Coordinate with revenue, coding and billing teams to resolve issues.
• Achieve established KPIs.
• Understand Medicaid regulations and IDHS MEDI system.
• Adhere to billing and compliance guidelines and maintain records.

Skills

Analytical thinking

Attention to detail

Communication skills

Independent work

Education

4+ years Medicaid billing experience

Tools

Epic EHR

Billing software

Job description

Prime Healthcare Illinois Medical Group in Chicago is seeking an Account Resolution Specialist to ensure timely follow-up with managed care and government payers by phone, review payer contracts, and uphold productive billing operations.

You will work with revenue, coding and billing teams to resolve denials, prepare appeal letters, and monitor KPIs while ensuring compliance with Medicaid regulations and accurate patient financial records.