Medicaid Claims Resolution Specialist

Prime Healthcare; Chicago (IL); On-site; USD 25,000 - 36,000; Full time

Job summary

Prime Healthcare Illinois Medical Group is seeking an Account Resolution Specialist to manage Medicaid billing follow-up and payer communications in a fast-paced setting. The role emphasizes timely A/R actions, denial resolution, and adherence to regulatory guidelines while coordinating with clinics and revenue teams.

The position requires 4+ years in medical billing with Medicaid focus, strong analytical skills, and proficiency in Epic EHR and MS Office.

Qualifications

• Minimum of 4 years of experience in medical billing, focused on Medicaid billing and follow-up.
• In-depth knowledge of Medicaid regulations, coding, and billing procedures.
• Experience with medical 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

• Responsible for A/R follow up to identify and resolve payer no response and denial issues.
• Follow up on unpaid claims to work towards resolution and collection on outstanding balances.
• Address and resolve denials received from payers through review of medical records and payer contracts, prioritizing high-dollar and aged claims.
• Compose and submit appeal letters and present a compelling case to overturn denials with payers.
• Identify and elevate denial patterns to leadership in a timely manner.
• Partner with operational and clinic leadership to identify processes leading to payer denial.
• Coordinate with revenue, coding and billing departments to resolve project issues.
• Achieve established KPIs.
• Understand Medicaid and Medicaid Managed Care regulations; experience with IDHS MEDI system.
• Adhere to all billing and compliance guidelines while maintaining accurate patient financial records.

Skills

Medicaid billing

Analytical skills

Communication

Multitasking

Microsoft Office

Problem solving

Tools

Epic EHR

Billing software

Microsoft Office

Job description

Prime Healthcare Illinois Medical Group is seeking an Account Resolution Specialist to manage Medicaid billing follow-up and payer communications in a fast-paced setting. The role emphasizes timely A/R actions, denial resolution, and adherence to regulatory guidelines while coordinating with clinics and revenue teams.

The position requires 4+ years in medical billing with Medicaid focus, strong analytical skills, and proficiency in Epic EHR and MS Office.