Medicaid Billing & Compliance Specialist (KCK, Topeka, Wichita)

FosterAdopt Connect•Kansas City, KS

35d

About The Position

Provides support to the BI Program completing monthly Medicaid billing and reporting. This role involves preparing, reviewing, and submitting Medicaid claims and invoices, verifying eligibility and billing information, auditing claims for compliance, and entering billing data into electronic systems. The specialist will research and resolve billing discrepancies, monitor claims through adjudication, and maintain knowledge of current Medicaid regulations. They will also reconcile claims with payments, prepare various billing and reimbursement reports, and identify trends to recommend process improvements. Collaboration with internal departments and external partners is key, as is serving as the primary resource for Medicaid billing processes. The role also includes assisting with procedure development and performing other assigned duties.

Requirements

Associate's degree in Accounting, Business Administration, Healthcare Administration, Health Information Management, or related field; equivalent experience may be considered.
Minimum two years of experience in Medicaid billing, medical billing, healthcare reimbursement, or behavioral health billing.
Adaptable and proactive self-starter who effectively multitasks while maintaining strong attention to detail and organization to meet all objectives and deadlines.
Collaborate effectively within diverse, multidisciplinary teams; adjust communication and work style to effectively engage diverse cultures, clients, colleagues, and external partners.
Proven ability to write clearly, concisely, and effectively for a variety of audiences.
Follow confidentiality guidelines and appropriate handling of sensitive information.
Model ethical and professional behaviors at all times.
Maintain flexibility in work schedule, including availability for evenings and weekends as needed.
Experience working with electronic health record systems and billing software.
Proficiency in Microsoft Excel and Microsoft Office Suite.
Strong analytical and problem-solving skills.

Nice To Haves

Bachelor's degree in Accounting, Business Administration, Healthcare Administration, or related field.
Experience billing Kansas Medicaid (KanKanCare) and/or Missouri Medicaid.
Experience billing behavioral health or community-based Medicaid services.
Knowledge of Medicaid Managed Care Organizations, including claim submission portals.
Experience with Alleva or similar electronic health record systems.
Experience interpreting Medicaid provider manuals, provider bulletins, and billing regulations.
Experience preparing financial, reimbursement, or operational reports.
Certified Professional Biller (CPB) or Certified Coding Associate (CCA) preferred but not required.

Responsibilities

Maintain strong, open communication with supervisors regarding billing activities, concerns or questions.
Actively contribute both independently and as part of a team; participate in team meetings and collaborate with colleagues across departments.
Prepare, review, and submit accurate and timely Medicaid claims for Behavioral Interventionist services in Kansas and Missouri, as well as invoices for other funding sources, by ensuring documentation meets billing requirements and agency standards.
Verify Medicaid eligibility, authorizations, provider information, and billing codes to ensure accurate and timely reimbursement.
Audit claims for completeness, accuracy, and compliance with federal, state, and Managed Care Organization (MCO) billing requirements.
Enter billing information into electronic health record and billing systems while maintaining accurate billing records and payment tracking.
Research billing discrepancies, payment variances, denials, underpayments, and overpayments, and coordinate with Medicaid representatives, Managed Care Organizations, and other payers to resolve outstanding issues.
Monitor claims through adjudication, track filing and reimbursement deadlines, follow up on outstanding claims as necessary, and submit corrected claims or adjustments.
Maintain current knowledge of Medicaid regulations and reimbursement requirements, communicate significant changes to program leadership, and support implementation of regulatory changes, billing software enhancements, and workflow improvements.
Ensure billing records, documentation, and reports comply with HIPAA and applicable federal, state, Medicaid, and agency requirements while supporting internal and external audits.
Reconcile submitted claims with payments received and assist with month-end billing reconciliation and accounts receivable tracking.
Prepare monthly, quarterly, and annual billing and reimbursement reports for the Behavioral Interventionist President, Chief Financial Officer, Finance Department, and other stakeholders as requested.
Develop and maintain reports related to claims submitted, payments received, denial rates, outstanding receivables, aging claims, revenue by funding source, and reimbursement trends.
Identify billing trends, denial patterns, and reimbursement opportunities, and recommend process improvements to enhance billing accuracy, compliance, and financial performance.
Collaborate with the Finance Department, Grants Department, Quality Improvement team, BI Data Analyst, and Behavioral Interventionist leadership to support accurate billing, reporting, and program compliance, and billing documentation best practices.
Serve as the Behavioral Interventionist Program's primary resource for Medicaid billing processes, claim resolution, and reimbursement questions.
Assist with developing, updating, and maintaining billing procedures, workflows, and standard operating procedures.
Perform other duties as assigned to support the Behavioral Interventionist Program and FosterAdopt Connect.