Medicaid Payer Resolution Specialist

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

Benefits offered by this job

401K retirement plan

Medical, dental, and vision coverage

Paid time off

Tuition reimbursement

Job summary

Prime Healthcare Illinois Medical Group is seeking an Account Resolution Specialist to manage Medicaid billing follow-up and payer interactions. You will communicate with health plans by phone, review denied claims, and support timely collections while ensuring compliance and accurate documentation.

Ideal candidates have 4+ years in medical billing, strong analytical abilities, and proficiency with EHRs (preferably Epic).

Qualifications

• Minimum of 4 years of experience in medical billing, with a focus on Medicaid billing and follow-up.
• In-depth knowledge of Medicaid regulations, coding, and billing procedures.
• Experience with medical billing software and electronic health records (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 the review of medical records and payer contracts, while prioritizing high dollars and aged claims.
• Ability to compose and submit appeal letters and represent a compelling case to overturn denials with payers.
• Identify and upscale 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
• Possesses an understanding of Medicaid and Medicaid Managed Care regulations and billing guidelines. Experience with IDHS MEDI system
• Adhere to all billing and compliance regulatory guidelines, while maintaining detailed and accurate patient financial records and documentation

Skills

Analytical skills

Problem-solving abilities

Effective communication

Interpersonal skills

Microsoft Office proficiency

Tools

Epic

Microsoft Excel

Job description

Prime Healthcare Illinois Medical Group is seeking an Account Resolution Specialist to manage Medicaid billing follow-up and payer interactions. You will communicate with health plans by phone, review denied claims, and support timely collections while ensuring compliance and accurate documentation.

Ideal candidates have 4+ years in medical billing, strong analytical abilities, and proficiency with EHRs (preferably Epic).