Medicaid Billing Specialist – New Jersey Medicaid | Fully Remote | $55,000/year

Summary

The company is a national managed healthcare organization serving individuals covered by Medicaid, Medicare, and other government-sponsored health programs. The Medicaid Billing Specialist manages New Jersey Medicaid billing for home care services, including claims submission, authorization tracking, eligibility verification, payment reconciliation, and resolution of billing issues.

Responsibilities

• Manage billing for New Jersey Medicaid-funded home care services
• Submit, review, and monitor claims through Medicaid and managed care organization (MCO) payer portals
• Obtain, review, track, and maintain client service authorizations
• Verify authorized hours, units, service codes, effective dates, and expiration dates
• Confirm member eligibility and coverage before submitting claims
• Review service records and supporting documentation for accuracy and consistency with authorizations
• Identify and resolve authorization discrepancies, missing information, and billing errors
• Monitor claim status and follow up on rejected, denied, unpaid, or underpaid claims
• Prepare corrected claims and supporting documentation for resubmissions or appeals
• Reconcile payments and remittance information, investigate discrepancies, and maintain accurate billing records
• Coordinate with internal teams and payer representatives to resolve issues affecting reimbursement
• Track outstanding claims, authorization renewals, and timely filing deadlines
• Maintain confidentiality and follow applicable privacy requirements and organizational procedures

Skills

• Experience billing New Jersey Medicaid, including familiarity with Medicaid and MCO payer portals
• Working knowledge of claims submission, claim status tracking, denial resolution, and reimbursement follow-up
• Experience reviewing and managing service authorizations
• Ability to verify authorized hours, units, service codes, and coverage dates
• Strong attention to detail, organizational skills, and follow-through
• Clear written and verbal communication skills
• Proficiency with billing software, electronic records, and Microsoft Excel
• Ability to work independently in a remote environment and manage competing deadlines
• Medicaid billing experience in home care, home health, and/or skilled nursing
• Familiarity with New Jersey Medicaid managed care and long-term services and supports
• Experience resolving claims affected by authorization limits, service documentation discrepancies, or eligibility issues

Qualifications

Must Haves

• Experience billing New Jersey Medicaid, including familiarity with Medicaid and MCO payer portals
• Working knowledge of claims submission, claim status tracking, denial resolution, and reimbursement follow-up
• Experience reviewing and managing service authorizations
• Ability to verify authorized hours, units, service codes, and coverage dates
• Strong attention to detail, organizational skills, and follow-through
• Clear written and verbal communication skills
• Proficiency with billing software, electronic records, and Microsoft Excel
• Ability to work independently in a remote environment and manage competing deadlines

Nice to Haves

• Medicaid billing experience in home care, home health, and/or skilled nursing
• Familiarity with New Jersey Medicaid managed care and long-term services and supports
• Experience resolving claims affected by authorization limits, service documentation discrepancies, or eligibility issues

Benefits

• Fully remote work arrangement