Medical Billing Specialist - Medicaid

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.

Key Responsibilities

• Review insurance coverage and patient demographic information for accuracy and completeness before billing
• Prepare, review, submit, and track claims to Medicaid payers in accordance with FQHC, state, and federal billing requirements
• Process reimbursements and reconcile remittance reports with payments received
• Monitor accounts receivable aging and follow up on unpaid or underpaid claims
• Identify Medicaid-related denial trends, payment issues, and eligibility discrepancies
• Resolve payment credits and overpayments through claim corrections, refunds, or payer coordination
• Maintain knowledge of FQHC billing rules and CPT, CDT, and ICD-10-CM coding requirements
• Respond to inquiries from patients, providers, and insurance representatives
• Coordinate with internal teams to resolve shared or complex claim issues
• Review and process correspondence related to claims and payments
• Maintain organized electronic claim, payment, and correspondence records for audits and reporting
• Protect patient information in accordance with HIPAA and confidentiality policies