Job: Billing Specialist

Title Billing Specialist
Job Information

Billing Specialist -Healthcare Facility

Full Time Position: Monday through Friday 9:00am – 5:30pm
Reports to: Chief Financial Officer

Job Summary: Billing and Collections; specializing in MMAI (Medicare-Medicaid Alignment Initiative), HCI (Health Choice Illinois) programs and Traditional Medicaid.


MMAI | HCI Billing: • Check claims for accuracy and submit for payment
• Follow-up on pending claims from previous billing periods
• Monitor claim processing on the online portals
• Take action and resolve issues with insurance companies (i.e. Claims that have not been processed)
• Compare pending UBs with A/R reports to confirm accuracy of claims
• Update A/R reports with received payments
• Keep up-to-date with changes in billing requirements
• Monitor changes in Census & the Electronic Health Record (EHR) to update member enrollment status
• Ensure member information is entered in the EHR
• Maintain Excel logs to reflect status of claims
• Maintain hardcopies of member files
• Keep track of insurance summaries for outstanding account balances

Authorizations • Set-up authorization when required for MMAI & MLTSS plans
• Provide the required documentation for processing of authorization requests
• Ensure that member authorizations are up to date

Education: Minimum of an Associates Degree in Business or related field of study or two-years of experience in related field

Experience: Working within an Electronic Health Record (i.e. PCC – Point Click Care) is helpful

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