Medicaid Billing Specialist (Temporary)

The Association for the Advancement of Mexican Americans•Houston, TX

31d•Onsite

About The Position

BASIC FUNCTION : Possess and apply thorough knowledge to all aspects of program billing processes including eligibility, coding, and insurance/payer requirements. Also responsible for accurate and timely grant and other billings and reports as assigned. This is a TEMPORARY Full Time Position. Approx 11/2025 thru 3/2026

Requirements

Experience and knowledgeable on governmental payers Medicare and Medicaid dealing with Substance Use Disorders.
Knowledgeable on the credentialing and recredentialing processes
Knowledgeable on insurance billing, collections, and reimbursement processes
High school diploma or GED required
Basic accounting skills, knowledge of Excel and other Microsoft Office products.
Must be available to work Monday-Friday, standard business hours
Strong organizational skills and attention to detail
Excellent written and verbal communication skills
Ability to work independently with minimal direction and oversight as well as with a team
Ability to handle multiple responsibilities under strict deadlines and prioritize efficiently
Familiarity with HIPAA privacy guidelines and maintains and protects all confidential information
Prolonged periods of using a computer and sitting at a desk.
Ability to review and analyze data and effectively communicate with internal and external customers.

Responsibilities

Ensures claim information is complete and accurate by reviewing claims for discrepancies
Identify potential issues as it relates to coding or insurance requirements and when needed, works with the proper staff member to correct errors
Monitor claim submission statistics via generated reports
Follows up with insurance companies on unpaid or rejected claims to determine and resolve any outstanding issues and re-submit corrected claims if necessary
Investigate, verify, and analyze patient’s eligibility results for any medical coverage and obtain proper billing contact information
Request or obtain documentation where applicable
Enters information necessary for insurance claims such as client, insurance, provider, as well as diagnosis recommended by LCDC, Licensed Chemical Dependency Counselor, treatment codes and modifiers if applicable.
Submits insurance claims to clearinghouse or individual insurance companies electronically or via paper
For clients with coverage by more than one insurer, prepares and submits secondary claims upon processing by primary payer
Follows HIPAA guidelines in handling patient information
Contact providers for credentialing and credentialing applications, gather and submit required documentation for credentialing.
Verify with the insurance company that the credentialing application was received, and follow up with the insurance network on a regular basis until your credentialing is complete and you have a network effective date with a participating provider agreement
Respond to any requests for additional information that the insurance company may have
Document all of your follow up activities as you go through the credentialing process
Review your participating provider contract for details of your requirements as a network provider, claims submission procedures, fee schedule for your services, timely filing limits, and all other important contract terms
Keep copies of all credentialing applications and contracts submitted. Retain a final copy of any network contracts
Generate reports for Director
Performs other duties as assigned.