medicaid billing specialist

Companion Home Care

Company OverviewCompanion Home Care is committed to enabling individuals to live life to the fullest in the comfort of their own homes. We provide compassionate and personalized care that promotes physical well-being, emotional stability, and self-determination. Our approach is rooted in understanding and compassion, as we strive to become part of your family.SummaryWe are seeking a Billing Specialist to join our team at Companion Home Care. This role is responsible for various duties related to authorizations, billing claims, posting payments, and collecting accounts receivable. Our team's goal is to reduce the organization's accounts receivable by keeping detailed accounting systems through our internal system. In this role, you will play a vital part in managing billing processes and ensuring accurate financial transactions related to our home care services and durable medical equipment transactions. Your work will contribute significantly to our mission of providing exceptional care while maintaining the dignity and respect our clients deserve.Responsibilities<ul><li>Create batch billing from time records and create all invoices for the clients as needed.</li><li>Submit and ensure all client&rsquo;s electronic billing is processed according to payer timely filing guidelines as needed.</li><li>Resolve all claim denials per the mandatory process.</li><li>Contact payer by phone, email, fax, or support ticket to resolve denials for client.</li><li>Review accounts receivable to identify posting or billing issues and resolve these issues.</li><li>Liaison between clients, payers, and office staff.</li><li>Post electronic and manual payments to accounts within mandatory process.</li><li>Process billing for services rendered, ensuring accuracy and compliance with regulations.</li><li>Maintain detailed records of billing transactions and client accounts.</li><li>Communicate with clients regarding billing inquiries and resolve any discrepancies.</li><li>Collaborate with healthcare providers to obtain necessary documentation for billing purposes.</li><li>Stay updated on changes in medical coding and billing regulations, including ICD-10 and ICD-9 codes.</li><li>Assist in the preparation of financial reports related to billing activities.</li></ul>*Requirements<ul><li>4+ years of experience in claims handling, healthcare billing, accounts receivable, aging reports, and/or posting payments.</li><li>Must have healthcare claims experience.</li><li>Must have excellent customer service skills.</li><li>Ability to work independently.</li><li>Strong attention to detail and high level of accuracy.</li><li>Ability to prioritize workload and maintain an organized system for processes.</li><li>Excellent written and verbal communication skills.</li><li>Proficiency in Microsoft Office products, including Outlook, Excel, and SharePoint.</li><li>Proven experience in personal care or general medical billing.</li><li>Familiarity with NC LME/MCOs and Tailored Plan billing processes.</li><li>Understanding of IDD terminology and NC Medicaid service definitions.</li><li>Strong knowledge of medical terminology and coding practices, including ICD-10.</li></ul>We invite you to apply today and become part of our dedicated team at Companion Home Care!Job Type: Full-timePay: $23.00 - $26.00 per hourBenefits:<ul><li>401(k)</li><li>Dental insurance</li><li>Disability insurance</li><li>Life insurance</li><li>Paid time off</li><li>Vision insurance</li></ul>Work Location: In person

Medicaid Billing Specialist

Bridging Gapss

Job Summary We are seeking a proactive and detail-oriented Medicaid &amp; 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<ul><li>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.</li><li>Review medical records and documentation to ensure proper coding of diagnoses and procedures, maintaining consistency with medical terminology and coding guidelines.</li><li>Collaborate with clinical staff to verify the completeness and accuracy of medical records prior to billing.</li><li>Monitor claim status through Electronic Medical Record (EMR) and Electronic Health Record (EHR) systems, following up on unpaid or denied claims promptly.</li><li>Conduct medical collections by communicating effectively with insurance providers, patients, and other stakeholders to resolve billing issues.</li><li>Ensure compliance with healthcare regulations, payer policies, and documentation standards throughout the billing process.</li><li>Maintain detailed records of all billing activities, claim submissions, adjustments, and correspondence for audit readiness.</li></ul>Experience/Qualifications<ul><li>Minimum of 2+ years of experience in Medicaid and/or MCO billing</li><li>Experience working with healthcare and CLTS billing a must.</li><li>Strong knowledge of billing systems and claim processes</li><li>Certification in medical billing/coding (CPC, CBCS, or similar) is a plus</li><li>High attention to detail and strong organizational skills</li><li>Ability to work independently and meet deadlines</li><li>Prior experience in medical billing or medical office administration with a focus on Medicaid or MCO claims is highly preferred.</li><li>Strong knowledge of medical coding systems including CPT, ICD-9, ICD-10, DRG classifications, and ICD coding standards.</li><li>Familiarity with medical terminology, medical records management, and healthcare documentation practices.</li><li>Experience working with EMR/EHR systems for claim processing and record keeping.</li><li>Excellent understanding of healthcare reimbursement processes, insurance policies, and collections procedures.</li><li>Ability to interpret complex billing guidelines and ensure accurate application of coding principles in a fast-paced environment. Join us as a Medicaid &amp; 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!</li></ul>Pay: $18.00 - $22.00 per hourBenefits:<ul><li>Flexible schedule</li></ul>Work Location: In person

Medicaid & MCO Billing Specialist

The Grand Healthcare System

<div>The Grand Rehabilitation and Nursing at Rome is currently seeking a Medicaid Coordinator to join our team! 
Position Type: Full-Time (8:00am to 4:00pm or 9:00am to 5:00pm) 
Pay Range: $25.00 to $28.00 per hour (with benefits)
Position Overview
We are looking for a highly organized and compassionate Medicaid Coordinator to manage a broad spectrum of financial and administrative functions in our skilled nursing facility. This full-time role combines the critical responsibilities of Medicaid processing, resident billing, collections, and business office operations. You'll work closely with residents, families, and interdisciplinary teams to ensure financial matters are handled with professionalism, clarity, and accuracy.
Key Responsibilities
Medicaid Coordination &amp; Application Support<ul><li>
Oversee Medicaid applications and recertifications for residents</li><li>
Assist residents and families with gathering required documentation and understanding eligibility criteria</li><li>
Track application statuses, respond to state agency requests, and ensure timely submission</li><li>
Maintain an accurate Medicaid pending list and monitor spend-down processes</li><li>
Review and maintain accurate financial records, including private pay accounts and Medicaid conversion billing</li><li>
Conduct meetings to explain billing, Medicaid, and insurance coverage clearly and compassionately</li></ul><ul><li>
Maintain compliance with all Medicaid, Medicare, and insurance guidelines</li><li>
Generate and submit reports related to billing, aging, Medicaid conversion, and collections as needed</li></ul>
Qualifications &amp; Requirements<ul><li>
2+ years of experience in a long-term care facility or skilled nursing setting</li><li>
Direct experience with Medicaid application and recertification processes</li><li>
Strong knowledge of billing procedures, Medicare/Medicaid rules, and managed care guidelines</li><li>
Excellent communication, customer service, and interpersonal skills</li><li>
Highly organized, with the ability to manage multiple tasks and deadlines</li><li>
Experience with electronic medical records and financial software systems (e.g., PCC, MatrixCare, etc.) preferred</li><li>
Knowledge of MEDS (Medicaid eligibility Decision System) - Required</li></ul>
What We Offer<ul><li>
Competitive Compensation: Salary commensurate with experience plus performance-based incentives</li><li>
Comprehensive Benefits: Medical, dental, vision, 401(k), paid time off, and more</li><li>
Career Development: Training and advancement opportunities within The Grand Healthcare System</li><li>
Positive Work Environment: A team-focused setting where your contributions are valued and supported</li></ul></div>

Medicaid Coordinator

Integrity Management Services, Inc.

<div>About Us
Integrity Management Services, Inc. (IntegrityM) is an award-winning, women-owned small business specializing in assisting government and commercial clients in compliance and program integrity efforts, including the prevention and detection of fraud, waste and abuse in government programs. Results are achieved through data analytics, technology solutions, audit, investigation, and medical review.
At IntegrityM, we offer a culture of opportunity, recognition, collaboration, and supporting our community. We thrive off of these fundamental elements that make IntegrityM a great place to work. Our small, flexible workplace offers an exceptional quality of life and promotes corporate-driven sustainability. We deliver creative solutions that exceed goals and foster a dynamic, idea-driven environment that nurtures our employees&rsquo; professional development. Large company perks&hellip;Small company feel!
www.integritym.com
In this role, the Medicaid Audit and Compliance Specialist will be responsible for performing and reporting on Medicaid Managed Care Plans and providers to identify potential fraud, waste, and abuse; issue findings and recommendations; and identify improper payments. Audit assignments can be programmatic or financial and may range from desk reviews and/or onsite review activities as determined by federal and state regulations. Specific review types may include case management, program payment appropriateness, program and policy compliance, billing, coding and medical record documentation reviews, as well as research and analysis of industry trends. The Medicaid Audit and Compliance Specialist will perform audits as assigned which consist of but are not limited to performing licensing and exclusion reviews on providers and work with the medical staff to ensure services are reimbursed meet regulatory requirements. The Medicaid Audit and Compliance Specialist will work independently as well as collaboratively with other audit staff. 
Job Responsibilities: 
<ul><li>
Applies in-depth knowledge of federal and state regulations and healthcare industry standards.</li></ul> 
<ul><li>
Comprehends and follows auditing plans and methodologies specific to contract requirements.</li></ul> 
<ul><li>Prioritization and assignment of workload, ensuring adherence to task order policies and procedures.</li></ul> 
<ul><li>
Examines and calculates data from financial documents and statements such as provider cost reports as a method of audit.</li></ul> 
<ul><li>
Utilize data mining and trend analysis tools to detect anomalies in Medicaid billing and payment patterns.</li></ul> 
<ul><li>
Attend on-site audits to retrieve medical records and conduct provider entrance/exit conference.</li></ul> 
<ul><li>
Prepare and submit medical record request letters to providers associated with requests for medical record requests or suspension overpayment determinations.</li></ul> 
<ul><li>
Interpret and apply pertinent laws, regulations, policies, and procedures relevant to the specific audit findings and provider type being audited.</li></ul> 
<ul><li>
Ensure Generally Accepted Government Auditing Standards (GAGAS) standards are applied to each applicable audit to identify fraud, waste or abuse.</li></ul> 
<ul><li>
Preparing factual and objective written reports in conformance with professional auditing and evaluation standards and present findings to leadership, external agencies, and government partners.</li></ul> 
<ul><li>
Calculates improper payments, and issues findings, recommendations, and corrective actions in accordance with applicable regulations, policies and procedures.</li></ul> 
<ul><li>Prepare and send suspension overpayment determinations to providers when applicable.</li></ul> 
<ul><li>
Communicates with federal/state agencies and providers regarding issues such as general regulatory compliance, audit findings, and the recovery process.</li></ul> 
<ul><li>
Attends briefings and presentations as assigned.</li></ul> 
<ul><li>
Maintains fraud case development quality standards so that proper case development is ensured, and quality cases are fully prepared.</li></ul> 
<ul><li>Maintains proper and timely updates in appropriate tools and applications for their investigations. Case development databases and documents.</li></ul> 
<ul><li>
Develops and documents reports of investigative findings, compiles case file documentation, calculates improper payments, and issues findings, recommendations, and corrective actions in accordance with applicable regulations, policies and procedures.</li></ul> 
<ul><li>Program research relating to federal program applications, eligibility, payments, and other program requirements.</li></ul> 
<ul><li>
Conducts on-site visits and/or interviews as required for investigation.</li></ul> 
<ul><li>Identify weaknesses in current audit processes and recommend enhancements for improved efficiency and effectiveness.</li></ul> 

Performs ad hoc tasks/duties as assigned. 
<ul><li>
</li></ul> 
 
Requirements 
<ul><li>
Bachelor&rsquo;s Degree in finance, accounting or related field required.</li><li>
5-7 Years of related experience in finance, accounting, or auditing.</li><li>
Intermediate knowledge of internal audit policies and operating principles.</li><li>
Intermediate knowledge and experience in auditing Medicare/Medicaid and other government payment and oversight programs. (CMS, HRSA, OIG, DOE, Dept. of Commerce etc.)</li><li>
Knowledge and experience in the application of government accounting principles and standards, including Generally Accepted Government Auditing Standards (GAGAS).</li><li>
Experienced investigative skills.</li><li>
Strong data analysis skills.</li><li>
Knowledge of medical terminology, ICD-9-CM, ICD-10-CM HCPCS level II and CPT codes. Utilizes Medicaid and Contractor guidelines for coverage determinations.</li><li>
Experience in reviewing claims for appropriate billing and medical coding requirements, performing medical review, and/or developing fraud cases.</li><li>
Strong oral and written communication skills, strong interpersonal skills, and superior organizational abilities.</li><li>
Ability to take initiative, to maintain confidentiality, to meet deadlines, and to work in a team environment.</li><li>
Ability to report work activity on a timely basis.</li><li>
Ability to work independently and as a member of a team to deliver high quality work.</li><li>
Ability to multitask and prioritize assignments while meeting deadlines.</li><li>
Proficiency in Microsoft Office, specifically Microsoft Word and Excel.</li><li>
Passion and alignment with IntegrityM&rsquo;s mission, vision, values and operating principles.</li></ul>
Additional Requirements:<ul><li>
Must pass post hire background screening checks.</li><li>
For remote work, required to have wired and/or wireless internet access.</li></ul></div>

Medicaid Audit and Compliance Specialist (Full-time, Remote)

FAMILY TIES, INC.

MUST HAVE MEDICAID &amp; MENTAL HEALTH BILLING EXPERIENCEAbout the RoleWe are seeking an experienced and highly organized Behavioral Health Billing Manager to join our growing team. This role is critical to ensuring accurate, compliant, and timely billing for behavioral health services. The ideal candidate is detail-oriented, proactive, and well-versed in Medicaid and Private insurance mental health billing, DBHDD policies and procedures, and provider credentialing.If you thrive in a fast-paced healthcare environment, enjoy problem-solving, and understand the importance of compliance in behavioral health services, this role is an excellent fit. This role goes beyond billing&mdash;it directly supports access to quality behavioral health care. You&rsquo;ll be part of a supportive, mission-driven team where your expertise ensures compliance, financial stability, and a smooth experience for both clients and providers. Your work truly makes a difference.Key ResponsibilitiesBilling &amp; Revenue Cycle Management<ul><li>Manage and maintain accurate, up-to-date client billing records</li><li>Review referrals, authorizations, and clinical documentation for billing compliance</li><li>Submit and track Medicaid and commercial insurance claims for mental health services</li><li>Ensure compliance with DBHDD, Medicaid, and payer-specific billing rules</li><li>Transfer and verify billing and insurance data with precision</li><li>Monitor accounts receivable and follow up on unpaid or denied claims</li><li>Investigate and resolve billing discrepancies and payment issues</li><li>Set up and manage payment plans when necessary</li><li>Send professional, timely payment reminders (friendly but firm)</li></ul>Insurance &amp; Compliance<ul><li>Verify insurance eligibility, benefits, and authorizations</li><li>Navigate Medicaid, HMOs, PPOs, and state-funded behavioral health programs</li><li>Stay current on DBHDD policies, Medicaid updates, and payer requirements</li><li>Serve as a point of contact for billing-related questions from clients and insurance companies</li></ul>Credentialing &amp; Provider Support<ul><li>Manageemployee and provider credentialing for Medicaid and other payers</li><li>Track credentialing and recredentialing timelines to ensure uninterrupted billing</li><li>Maintain organized credentialing files and documentation</li></ul>Required Qualifications<ul><li>Minimum 2+ years of Medicaid billing experience (REQUIRED)</li><li>Mental health / behavioral health billing experience (REQUIRED)</li><li>Strong knowledge of DBHDD policies and procedures (REQUIRED)</li><li>Experience with employee/provider credentialing (REQUIRED)</li><li>Bachelor&rsquo;s degree in Accounting, Healthcare Administration, Finance, Business, or related field (preferred)</li><li>Proficiency in Microsoft Office (Excel required); QuickBooks experience strongly preferred</li><li>Excellent multitasking, time management, and organizational skills</li><li>Ability to work independently and take initiative</li><li>Strong communication and customer service skills</li><li>Ability to clearly explain billing and insurance information to clients and payers</li><li>High attention to detail and strong problem-solving skills</li></ul>Benefits<ul><li>401(k)</li><li>Health Insurance</li><li>Dental Insurance</li><li>Vision Insurance</li><li>Paid Time Off</li><li>Referral Program</li></ul>Why Join Us? This is more than just numbers and spreadsheets&mdash;it&rsquo;s about helping people get the care they need, ensuring their billing experience is smooth, and making sure nothing falls through the cracks. You'll be part of a supportive team where your work truly matters.Job Type: Full-timePay: $45,000.00 - $50,000.00 per yearBenefits:<ul><li>401(k)</li><li>Dental insurance</li><li>Health insurance</li><li>Paid time off</li><li>Referral program</li><li>Vision insurance</li></ul>Experience:<ul><li>Behavioral Health Billing : 2 years (Required)</li></ul>Ability to Commute:<ul><li>Atlanta, GA 30328 (Required)</li></ul>Work Location: Hybrid remote in Atlanta, GA 30328

Behavioral Health Billing Manager

Oregon Youth Authority

OREGON YOUTH AUTHORITYAccountant 1 - Medical Billing SpecialistSalem, OR &ndash; Equitable CenterThe Oregon Youth Authority is seeking an Accountant 1 &ndash; Medical Billing Specialist to provide essential financial and accounting support that ensures the accuracy, integrity, and timeliness of agency transactions and reporting. In this role, you will collaborate with staff across the organization to perform complex accounting functions, apply established methods and controls, and support informed decision-making through reliable financial data.A primary focus of this position is managing Medicaid billing processes, including targeted case management (TCM), Behavioral Rehabilitation Services (BRS), and reimbursements through the Medicaid Management Information System (MMIS). Responsibilities include reviewing and verifying medical billing codes and reimbursement rates for provider payments; tracking and maintaining documentation supporting reimbursement claims to ensure accuracy, completeness, and audit compliance; and reviewing and analyzing remittance advice from the Oregon Health Authority (OHA) to verify paid and denied claims, identify discrepancies, and ensure compliance with Medicaid requirements.As a subject matter expert in medical payment claims, you will provide guidance on billing practices, resolve discrepancies, and ensure sensitive financial and medical information is handled in accordance with OYA policy, HIPAA, and other applicable standards. This role plays a critical part in supporting expenditure recovery, fiscal accountability, and compliance while contributing to a collaborative, inclusive, and mission-driven work environment.Top Duties of the Position:<ul><li>Review and verify medical billing codes and reimbursement rates for payments to providers</li><li>Track and maintain records supporting reimbursement claims, ensuring accuracy, completeness, and compliance with audit requirements.</li><li>Review and analyze remittance advice from the Oregon Health Authority (OHA) to verify accuracy of paid and denied claims, identify discrepancies, and ensure compliance with Medicaid billing and reimbursement requirements.</li></ul>Minimum Qualifications:Possession of a Certified Public Accountant or Certified Government Financial Manager certificate; ORA bachelor&rsquo;s degree in accounting; ORSuccessful completion of the State of Oregon Accounting Career Mobility Program or equivalent accounting certificate program from an accredited college or university; OR32 quarter (21 semester) credit hours in Accounting from an accredited institution two years of technical, para- professional accounting experience to include: a) classifying, analyzing, and reconciling financial data and records; b) designing, recommending, and installing modifications of accounting methods, procedures, forms, and records; c) preparing financial statements and reports; d) analyzing and interpreting laws, regulations, codes, and ordinances to ensure the legality of financial transactions; and e) analyzing, interpreting, and making recommendations related to accounting transactions, accounts and account relationships resulting in accounting entries.Required Skills:<ul><li>Ability to work with diverse groups of internal clients.</li><li>Excellent attention to detail and number typing accuracy.</li><li>Proficiency in Excel and other relevant software (e.g., ORMB, Epic Tapestry Membership, SharePoint).</li><li>Knowledge of ICD-9/ICD-10, HCPCS, CPT coding conventions.</li><li>Ability to work to tight deadlines in a fast-paced environment.</li><li>Ability to maintain professionalism, confidentiality, and objectivity under pressure.</li><li>Knowledge of medical terminology and regulations on the confidentiality of medical records (HIPAA).</li><li>Possess an understanding of basic principles of governmental accounting and financial reporting.</li><li>Ability to apply accounting theory to solve or evaluate solutions to problems and to document and communicate the application of theory.</li><li>Must remain current with the capabilities of various software applications as well as other aspects of the profession by attending training/education sessions.</li></ul>Desired Attributes:<ul><li>Experience with HIPAA requirements for information handling</li><li>Experience with medical billing, including reviewing HCFA forms and ICD-10 coding</li><li>Demonstrated experience with Medicaid billing requirements, specifically related to Title XIX program</li><li>Demonstrated experience with financial reconciliations</li><li>Demonstrated problem-solving skills, critical thinking skills, and oral and written communication skills</li><li>Positive, professional, and reliable</li></ul>How to Apply: <ul><li>COVER LETTER AND RESUME REQUIRED: In your cover letter, please describe your experiences, skills, and knowledge as they relate to the desired attributes of the position and explain why you are the best fit for this role. Limit your cover letter to no more than 2 pages and ensure it is in PDF format for accessibility.</li><li>Ensure your application and/or resume thoroughly reflect your skills, experience (both lived and professional), knowledge, and/or education pertinent to this position, including how you meet the minimum qualifications and any/all desired attributes. Include in your resume dates of employment and descriptions of duties/responsibilities for each position.</li><li>After you submit your application, please respond to the public records request authorization and gender identity questionnaire. This step will come after you submit and will complete the process. If you are an employee, the tasks will come to your Workday inbox.</li><li>If you are a veteran, you may receive preference. Click here for more information about veterans&rsquo; preference. The task to claim preference will come after the public records request and gender identity questionnaire tasks. Click here for a guide on how to upload your documents. For privacy reasons, please do not attach your DD214/DD215/civil service preference letter to your application or combine it with any other required document attachments.</li></ul>Caution: If you fail to follow these instructions, including failing to attach a resume and cover letter as described above, we will have to disqualify your application. We cannot consider incomplete or late applications. Additional Details:<ul><li>Hybrid Telework: This position is eligible for a hybrid remote work schedule; you will be required to come into the office 3-4 days per month. Employees may be required to be in the office more frequently in response to business needs. Remote work is evaluated periodically to ensure business needs are being met and can be adjusted at any time.</li><li>This recruitment will be used to establish a list of qualified candidates to fill current and future vacancies.</li><li>Your application materials are used to determine your starting salary range. Through an equal pay assessment, we will determine the salary offer using the information you provide in your submitted application materials. Please ensure your application materials are detailed, accurate and reflect your skills, experience (paid and unpaid) and education as they relate to the position when applying. For more information on pay equity, click here.</li><li>The salary range listed is the non-PERS participating rate. If you are already a participating PERS member or once you become PERS eligible, the salary range will increase by 6%. Please review the Classification and Compensation page for more details.</li><li>This position receives annual increases on the anniversary date until the maximum of the salary range is reached.</li><li>Please save a copy of this job announcement for your reference, as it may not be available for you to view after the job closes.</li></ul>Tentative Recruitment Schedule:<ul><li>1st Round Interviews (virtual - Teams): April 29, 2026</li><li>2nd Round Interviews (in-person): May 6, 2026</li></ul>Would you like to learn more about this position or how our application process works? Join our Recruitment team during our OYA Career Chat Sessions every other Wednesday between 11am-11:30am PST. We can assist you with all your application and agency questions!Click Here to Register for OYA Career Chats!ABOUT OYAAt OYA, diversity, equity, and inclusion are more than just words on a page. To meet our mission and live our values as an agency, DEI must be at the heart of all we do. We support cultural competence, develop teams and cultivate leaders in ways that are equitable to everyone, especially people of color, those who identify as LGBTQ+, or those from other marginalized communities. We are explicit and intentional as we identify resources that all our youth and staff need to grow and prosper. Our DEI work connects closely with our culture of positive human development, with safe and supportive environments where everyone is held accountable and connected to their community. The end goal is to protect the public and reduce crime by holding youth accountable and providing opportunities for reformation in safe environments.If you are looking to join a team that values individual and cultural differences, with the opportunity to contribute to youth reformation by enriching our workforce with diversity, OYA wants to hear from you! People of color, women, and other members of historically marginalized communities are strongly encouraged to apply!For more information please visit www.oregon.gov/oya.What's in it for You? OYA values our employees. We believe that your time outside of the workplace is as valuable as it is inside the workplace. We offer a great work/life balance with flexible work schedules on most positions and a competitive benefits package, including low-cost, high-coverage health insurance, generous time-off, and a competitive retirement plan.Discover more about working in Oregon state government by clicking here.This position is represented by the Service Employees International Union (SEIU/OPEU). By joining and maintaining your membership with SEIU Local 503, the following benefits are available to you such as:<ul><li>$2,500 life insurance policy paid for by your union, SEIU Local 503. This policy is in effect if you are an active member.</li><li>Up to $200,000 of additional life insurance can be purchased. Up to $100,000 member life, $40,000 spouse and $10,000 child is guaranteed within the first 90 days of new union membership.</li><li>Short Term Disability insurance is guaranteed if purchased within the first 90 days of new union membership.</li><li>Legal insurance enrollment is available to purchase within the first 90 days of new union membership.</li><li>Tuition reimbursement.</li></ul>For more information on SEIU, please click here.Additional Information:Our goal is to be a diverse workforce that is representative, at all job levels, of the citizens we are here to serve. OYA is an equal opportunity and affirmative action employer. All aspects of employment including the decision to hire, promote, discipline, or discharge, will be individualized based on merit, competence, performance, and business need.We do not discriminate on the basis of race, color, religion, marital status, age, national origin, ancestry, physical or mental disability, medical​​​ condition, pregnancy, genetic information, gender, sexual orientation, gender identity or ​expression, veteran status, or any other status protected under federal, state, or local law.&rdquo; The more diverse we are, the better our work will be.Applicants with a disability may request a reasonable accommodation to participate in the hiring process. For assistance regarding reasonable accommodation or for alternative format please contact OYA Recruitment at 971-345-1236. Oregon Relay Service can be reached by calling 7-1-1.Pre-employment Checks: In keeping with our mission, OYA will conduct a criminal record check, per OAR 416 Division 800, a driving record background check and a vulnerable population abuse and neglect check. Information obtained about an individual is confidential. An individual who refuses to consent to a criminal records/background check shall be disqualified from consideration in the position for which you applied. All applicants are subject to additional pre-employment check(s) such as fingerprint based on criminal records check, pre-employment drug screening and/or education verification as required for the position.In 2003 Congress passed the Prison Rape Elimination Act (PREA), the first federal civil statue focused specifically on addressing sexual violence in juvenile facilities, jails, prisons, and other facilities. In recognition of the rights, safety, and well-being of the youth we serve you will be asked specific questions about your background to ensure our hiring and promotion practices comply with the National PREA standards.All positions in OYA will require the incumbent to serve as a &quot;mandatory reporter&quot; of child abuse.Visa Sponsorship:We do not offer Visa sponsorship. If you are hired, you will be required to fill out the US Department of Homeland Security&rsquo;s I-9 form confirming you are able to work in the US. OYA uses E-Verify to confirm that applicants are authorized to work in the United States.Have Questions?: For questions about the job announcement, email the OYA recruitment team at OYAjobs@oya.oregon.gov.Pay: $4,519.00 - $6,904.00 per monthBenefits:<ul><li>Employee assistance program</li><li>Flexible spending account</li><li>Health insurance</li><li>Life insurance</li><li>Paid time off</li><li>Parental leave</li><li>Retirement plan</li><li>Vision insurance</li></ul>Work Location: Hybrid remote in Salem, OR 97301

Accountant 1 - Medical Billing Specialist

State of Michigan

<div><div><div><h2 class="jobSectionHeader">Job Description</h2></div>
<div>The MDHHS mission is to provide opportunities, services, and programs that promote a healthy, safe, and stable environment for residents to be self-sufficient. We are committed to ensuring a diverse workforce and a work environment whereby all employees are treated with dignity, respect and fairness. For more information, please visit our MDHHS Diversity, Equity, and Inclusion Plan. (Download PDF reader) 
 
Medicaid Utilization Analyst 12 
This position functions as a clinical review professional responsible as the senior analyst conducting clinical reviews of applications/requests for prior authorization of clinical services, procedures, supplies, and/or equipment provided to Medicaid and Children&rsquo;s Special Health Care Services beneficiaries, and to provide technical assistance and consultation regarding services, products, technology, and standards of coverage. These reviews require a more in-depth analysis and do not fall within the standard parameters of the normal review process. This position may function in a liaison capacity and/or will consult with Office of Medical Affairs clinicians as needed. This position will participate as an alternate to assure operational turnaround time is met. The expertise of the position is relied upon for formation and interpretation of Medicaid policy, to provide technical knowledge for coverage and service inquiries, to advise on standards of coverage, and to prepare summaries and testify at Administrative Hearings and Department Reviews. The position also serves as the consultant to other department staff, vendors, providers, and beneficiaries for coverage decisions and policy coverage, as well as providing training for less experienced/new division staff. 
A-Level Position Description (Download PDF reader) 
 
Medicaid Utilization Analyst 9 to P11 
This position functions as a clinical review professional responsible for conducting clinical reviews of applications/requests for prior authorization of clinical services, procedures, supplies, and/or equipment provided to Medicaid and Children's Special Health Care Services beneficiaries, and to provide technical assistance and consultation regarding services, products, technology, and standards of coverage. This position may rely on consultation with more senior staff for reviews of higher-than-normal complexity and will consult with Office of Medical Affairs clinicians as needed. This position will participate as an alternate to assure operational turnaround time is met. The day-to-day PA review experience of the position is relied upon to contribute information from provider submissions, notifying senior staff responsible for formation and interpretation of Medicaid policy and provision of technical knowledge for coverage and service inquiries. This position also prepares summaries and testifies at Administrative Hearings and Department Reviews, and provides basic consultation and information to address PA-related questions within BPHASA and to other departments and agencies, seeking guidance from senior level staff as needed. 
E-Level Position Description 
 
Job Specification 
To be considered for this position you must:<ul><li>
Apply for this position online via NEOGOV; click on &quot;Apply&quot; in the job posting for instructions on submitting your electronic application. Hard copy applications are not accepted.</li><li>
Relevant experience and/or education referred to in the supplemental questions must be documented in the resume, transcript and/or application to allow for accurate screening.</li><li>
Attach a resume identifying specific experience and dates of employment. Dates of employment should include month and year and hours per week.</li><li>
Attach a cover letter.</li><li>
If applicable, attach a copy of an official transcript(s). We accept scanned copies of official transcripts. We do not accept web-based, internet, or copies of unofficial transcripts. Official transcripts provide the name of the institution, confirmation that a degree was awarded and on what date, and the registrar's signature.</li></ul>
Failure to complete any of the above items may result in your application not being considered. See instructions for attaching files here: Instructions (Download PDF reader)</div> 

<div><h2 class="jobSectionHeader">Required Education and Experience</h2></div>
<div>Education 
Possession of a bachelor's degree in audiology, dental hygiene emergency medical technician, medical records administration, medical technology, nuclear medicine technology, nursing, occupational therapy, pharmacy, physician assistant, physical therapy, radiologic technology, rehabilitation, respiratory therapy, speech pathology, or sports medicine. 
 
Experience 
Medicaid Utilization Analyst 9 - No specific type or amount is required. 
Medicaid Utilization Analyst 10 - Two years of professional experience providing clinical patient care requiring documentation of services provided, patient progress, etc. (e.g. nursing/therapy services); or; one year of professional experience analyzing health services or health services utilization data equivalent to a Medicaid Utilization Analyst 9. 
Medicaid Utilization Analyst P11 - Four years of professional experience providing clinical patient care requiring documentation of services provided, patient progress, etc. (e.g. nursing/therapy services); or; two years of professional experience analyzing health services or health services utilization data equivalent to a Medicaid Utilization Analyst, including one year equivalent to a Medicaid Utilization Analyst 10. 
Medicaid Utilization Analyst 12 - Three years of professional experience analyzing health services or health services utilization data equivalent to a Medicaid Utilization Analyst, including one year equivalent to a Medicaid Utilization Analyst P11.</div>
<div><h2 class="jobSectionHeader">Alternate Education and Experience</h2></div>
<div>Medicaid Utilization Analyst 9-12 
Possession of a bachelor's degree in allied health, health education, health sciences, health care administration, chiropractic, health care management, health systems management, and health studies and licensure/certification in a clinical health care field may be substituted for the education requirement. 
 
Medicaid Utilization Analyst 12 
Two years of experience as a Registered Nurse P11 or equivalent may be substituted for the education requirement.</div>
<div><h2 class="jobSectionHeader">Additional Requirements and Information</h2></div>
<div>The physical location of this position is Capitol Center Commons, 400 S. Pine, Lansing, MI. Based on operational needs and within established limits, remote work and alternate or hybrid work schedule requests for this position may be considered.
Selected candidates who have been approved to work remotely or a hybrid schedule must complete that work within Michigan. Candidates should confirm work location and schedule at the time of interview.
Employees will be provided computers to perform state work. Phones may also be provided for necessary communications. If working remotely, employees will be responsible for providing other components of a remote office at their own expense, including:<ul><li>
A secure work location that allows privacy and prevents distractions.</li><li>
A high-speed internet connection of at least 25 Mbps download and 5 Mbps upload.</li><li>
Suitable lighting, furniture, and utilities.</li></ul> 
As a Condition of Employment: this position requires successful completion of a background investigation and a criminal records check. 
 
The Department of Health &amp; Human Services reserves the right to close this posting prior to its original end date once a sufficient number of applications have been received.
For information about this specific position, please email MDHHSVacancies@michigan.gov. Please reference the job posting number in subject line.
Your application for any position does not guarantee you will be contacted by the Department/Agency for further consideration. Only those applicants interviewed will be notified of the results.
The use of artificial intelligence (AI) software of any kind is prohibited in all areas of the selection process; including, but not limited to, responses to application questions, and responses to interview questions or exercises. 
 
If you previously held status in this classification and departed within the last three (3) years, please contact Human Resources regarding your interest in a potential reinstatement. Reinstatement is not guaranteed or required. 
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MDHHS is proud to be a Michigan Veteran&rsquo;s Affairs Agency (MVAA) Gold Level Veteran-Friendly Employer</div>
</div><div></div><div><div>Accommodations 
If you require a reasonable accommodation to participate in the application or selection processes, please contact the ADA coordinator (Download PDF reader) for the agency that posted this position vacancy.</div></div></div>

Medicaid Utilization Analyst 9-12 - HS MEDICAL EQUIPMENT & SERVICES SECTION- PACER

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