Medical Billing Specialist - Medicaid

Medical Billing Specialist

Health Partners of Western Ohio is an independent, non-profit and community-directed organization. We serve low-income areas and places without access to care. We're led by a volunteer Board of Directors. Most of our board members are also patients. Our mission is to eliminate gaps in health outcomes for all members of our community by providing access to quality, affordable, preventive and primary health care.

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.

Essential Functions and Basic Duties:

• Review insurance coverage and patient demographic information to ensure accuracy and completeness prior to billing
• Prepare, review, submit, and track insurance claims to Medicaid payers in accordance with FQHC, state, and federal billing requirements
• Process insurance reimbursements and reconcile remittance reports with payments received
• Monitor accounts receivable aging and actively follow up on unpaid or underpaid claims
• Identify Medicaid-related denial trends, systemic payment issues, and eligibility discrepancies
• Resolve payment credits and over payments through claim corrections, refunds, or payer coordination in compliance with state and federal regulations
• Maintain current knowledge of FQHC billing rules, CPT, CDT, and ICD-10-CM coding requirements
• Respond professionally and knowledgeably to inquiries from patients, providers, and insurance representatives
• Coordinate with internal teams (including Medicare, Managed Medicaid, and third-party insurance teams) to resolve shared or complex claim issues
• Review and process incoming correspondence related to claims and payments
• Maintain organized electronic claim, payment, and correspondence records to support audits and reporting
• Safeguard patient information in accordance with HIPAA and health center confidentiality policies
• Perform other job-related duties as assigned

Qualifications:

• High School Degree or GED Required
• Successful completion of in-house training
• Experience with healthcare billing preferred

Skills/Abilities:

• Working knowledge of multiple insurance types, including Medicaid, Medicare, and commercial payers
• Understanding of basic medical and billing terminology
• Ability to manage time effectively and prioritize tasks in a deadline-driven environment
• Strong analytical skills with the ability to critically evaluate available information and make informed decisions
• Moderate technical proficiency with the ability to work simultaneously across multiple systems and platforms, including Excel, practice management systems, and Microsoft Teams

What We Offer:

• Starting pay $21.60 and goes up based on experience in Federally Qualified Health Center billing
• Paid Time Off (PTO) – Accrued per pay
• Insurance (Medical, Dental, Vision, Life and Disability)
• Paid Holidays – 7 paid holidays
• 403b Retirement with up to 8% match (starts at 3% and increases with time of service at HPWO)
• Annual Reviews and Increases
• Employee Assistance Program
• Referral Bonus – Earn more by expanding our team
• Training Opportunities
• Eligible to apply for the Emerging Leaders Program after 1 year of service