The Medical Billing Coordinator manages Medicaid and Managed Care Organization (MCO) billing activities for designated agency programs. This role oversees claim submission, reimbursement tracking, denial management, payment reconciliation, and accounts receivable follow-up to support timely and accurate revenue collection.
The position serves as the primary resource for payer-related billing matters, including eligibility issues, authorization requirements, rate changes, retroactive adjustments, prorated billing calculations, and reimbursement discrepancies. It works closely with Finance, Program, and external payer representatives to improve reimbursement, strengthen billing processes, and support expansion of billable services.
Essential duties
- Prepare, review, and submit weekly electronic medical claims to third-party payers.
- Monitor claim status throughout the billing cycle.
- Investigate and resolve denied, suspended, underpaid, or rejected claims.
- Maintain billing records and supporting documentation for compliance.
- Review admissions, discharges, transfers, authorizations, and census information for billing accuracy.
- Review remittance advice and payment reports to confirm reimbursement accuracy and identify collection opportunities.
- Process billing adjustments for rate changes, retroactive eligibility, payer updates, and prorated service periods.
- Perform accounts receivable follow-up to maximize collections and reduce outstanding balances.
- Identify reimbursement opportunities from retroactive approvals, claim corrections, payer errors, and billing discrepancies.
- Maintain knowledge of Medicaid, MCO, and payer billing requirements.
- Coordinate with billing software representatives to resolve technical issues.
- Support internal and external staff in resolving billing issues.
- Implement billing and reporting processes within medical billing software.
- Create reports to monitor managed care and insurer approvals and payment processing.
- Generate reports for Finance for entry into QuickBooks.
- Provide backup support to other Finance department staff as needed.
Qualifications
- Associate degree in Medical Billing and Coding, Healthcare Administration, Business, Accounting, or a related field preferred.
- Equivalent education and experience may be considered.
- 3 to 5 years of experience in medical billing, managed care billing, Medicaid billing, behavioral health billing, or related reimbursement functions.
- Experience with claim denials, appeals, accounts receivable follow-up, payment reconciliation, and reimbursement analysis.
- Strong knowledge of Medicaid and managed care billing requirements preferred.
- Valid New York State driver’s license and reliable automobile required.
Benefits
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Professional development assistance
- Referral program
- Vision insurance
Location
Buffalo, New York, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
1 month ago