Medicaid & MCO Billing Specialist

Job Summary
We are seeking a proactive and detail-oriented Medicaid & MCO Billing Specialist to join our dynamic healthcare team. In this role, you will be responsible for managing the billing processes related to Medicaid and Managed Care Organization (MCO) claims, ensuring accurate and timely reimbursement for services rendered. Your expertise in medical coding, billing procedures, and healthcare regulations will be essential in optimizing revenue cycles while maintaining compliance with all relevant policies. This position offers an exciting opportunity to contribute to a mission-driven organization dedicated to delivering high-quality care and support to our community.

Responsibilities

• Prepare and submit Medicaid and MCO claims accurately using appropriate coding standards such as CPT (Current Procedural Terminology), ICD-9, ICD-10, and DRG (Diagnosis-Related Group) classifications.
• Review medical records and documentation to ensure proper coding of diagnoses and procedures, maintaining consistency with medical terminology and coding guidelines.
• Collaborate with clinical staff to verify the completeness and accuracy of medical records prior to billing.
• Monitor claim status through Electronic Medical Record (EMR) and Electronic Health Record (EHR) systems, following up on unpaid or denied claims promptly.
• Conduct medical collections by communicating effectively with insurance providers, patients, and other stakeholders to resolve billing issues.
• Ensure compliance with healthcare regulations, payer policies, and documentation standards throughout the billing process.
• Maintain detailed records of all billing activities, claim submissions, adjustments, and correspondence for audit readiness.

Experience/Qualifications

• Minimum of 2+ years of experience in Medicaid and/or MCO billing
• Experience working with healthcare and CLTS billing a must.
• Strong knowledge of billing systems and claim processes
• Certification in medical billing/coding (CPC, CBCS, or similar) is a plus
• High attention to detail and strong organizational skills
• Ability to work independently and meet deadlines
• Prior experience in medical billing or medical office administration with a focus on Medicaid or MCO claims is highly preferred.
• Strong knowledge of medical coding systems including CPT, ICD-9, ICD-10, DRG classifications, and ICD coding standards.
• Familiarity with medical terminology, medical records management, and healthcare documentation practices.
• Experience working with EMR/EHR systems for claim processing and record keeping.
• Excellent understanding of healthcare reimbursement processes, insurance policies, and collections procedures.
• Ability to interpret complex billing guidelines and ensure accurate application of coding principles in a fast-paced environment. Join us as a Medicaid & MCO Billing Specialist to make a meaningful impact through precise billing practices that support quality patient care while advancing your professional expertise in healthcare finance!

Pay: $18.00 - $22.00 per hour

Benefits:

• Flexible schedule

Work Location: In person