Medical Billing Specialist - Medicaid

Health Partners; Lima (OH); Presencial; USD 42.000 - 62.000; Jornada completa

Descripción de la vacante

Health Partners of Western Ohio is seeking a Fulltime In Person Accounts Receivable Specialist in Lima, OH. You will manage Medicaid claims, ensure accurate billing, and support the revenue cycle within a nonprofit health care setting.

Responsibilities include reviewing coverage, submitting claims, reconciling payments, and collaborating with internal teams to resolve complex deny issues while maintaining coding compliance with CPT, CDT, and ICD-10-CM guidelines.

Formación

• Knowledge of FQHC billing requirements.
• Experience reviewing insurance coverage and patient demographics for billing.
• Familiarity with Medicaid payers and remittance processing.
• Ability to coordinate with internal teams on claim issues.
• Knowledge of CPT, CDT, ICD-10-CM coding.

Responsabilidades

• Review insurance coverage and patient demographic information for billing accuracy.
• Prepare, submit, and track insurance claims to Medicaid payers per rules.
• Process reimbursements and reconcile remittance with payments.
• Monitor accounts receivable aging and follow up on unpaid or underpaid claims.
• Identify denial trends and eligibility discrepancies; resolve credits and overpayments.
• Maintain knowledge of FQHC billing rules and coding requirements.
• Respond to inquiries from patients, providers, and insurers.
• Coordinate with Medicare, Managed Medicaid, and third-party teams to resolve issues.
• Review incoming correspondence related to claims and payments.
• Maintain organized electronic claim records for audits.

Descripción del empleo

Fulltime In Person (Monday - Friday 8:00 am - 4:30 pm)

About Us

Health Partners of Western Ohio is an independent, non-profit and community-directed organization. We serve low-income areas and places without access to care. We're led by a volunteer Board of Directors. Most of our board members are also patients. Our Mission is to eliminate gaps in health outcomes for all members of our community by providing access to quality, affordable, preventive and primary health care.

SUMMARY

POSITION PURPOSE With knowledge of FQHC billing requirements, the Accounts Receivable Specialist prepares, submits, and follows up on insurance claims to the state Medicaid program to support an efficient and effective revenue cycle.

ESSENTIAL FUNCTIONS AND BASIC DUTIES

• Review insurance coverage and patient demographic information to ensure accuracy and completeness prior to billing
• Prepare, review, submit, and track insurance claims to Medicaid payers in accordance with FQHC, state, and federal billing requirements
• Process insurance reimbursements and reconcile remittance reports with payments received
• Monitor accounts receivable aging and actively follow up on unpaid or underpaid claims
• Identify Medicaid-related denial trends, systemic payment issues, and eligibility discrepancies
• Resolve payment credits and overpayments through claim corrections, refunds, or payer coordination in compliance with state and federal regulations
• Maintain current knowledge of FQHC billing rules, CPT, CDT, and ICD-10-CM coding requirements
• Respond professionally and knowledgeably to inquiries from patients, providers, and insurance representatives
• Coordinate with internal teams (including Medicare, Managed Medicaid, and third-party insurance teams) to resolve shared or complex claim issues
• Review and process incoming correspondence related to claims and payments
• Maintain organized electronic claim, payment, and correspondence records to support audits and reporting