Insurance Biller

Medicaid/Private Insurance Biller

Department: Billing / Revenue Cycle Management

Reports To: Billing Manager or Chief Financial Officer

Employment Type: Contract or Part\-time (as applicable)

### Position Summary

The Medicaid/Private Insurance Biller is responsible for accurately preparing, submitting, and following up on insurance claims to ensure timely reimbursement for services rendered. This role requires strong knowledge of billing rules, attention to detail, and effective communication with internal teams and state Medicaid agencies. The Biller plays a critical role in maintaining the financial health of the practice while ensuring compliance with state and federal regulations.

### Key Responsibilities

Claims Preparation \& Submission

• Prepare, review, and submit Medicaid and private insurance claims accurately and timely using electronic billing systems.
• Verify patient Medicaid and private insurance eligibility, coverage dates, and required authorizations prior to claim submission.
• Ensure services billed are supported by appropriate documentation and compliant with Medicaid guidelines.

Payment Posting \& Reconciliation

• Post medical insurance payments, adjustments, and denials accurately into the billing system.
• Reconcile remittance advice (EOBs/ERAs) with submitted claims.
• Identify and report underpayments or discrepancies.

Denials \& Follow\-Up

• Research, correct, and resubmit denied or rejected Medicaid and private insurance claims.
• Track claim status and follow up with Medicaid and/or private insurance payers as needed.
• Work denials to resolution within established timelines.

Compliance \& Documentation

• Maintain up\-to\-date knowledge of Medicaid and/or private insurance billing regulations, coding updates, and payer\-specific rules (state\-specific Medicaid programs).
• Ensure compliance with HIPAA, CMS, and organizational policies.
• Maintain accurate billing records and audit\-ready documentation.

Collaboration \& Communication

• Work closely with intake, referrals, clinical staff, and authorization teams to resolve billing issues.
• Communicate professionally with Medicaid representatives regarding claims and payment inquiries.
• Provide feedback to internal teams on recurring billing or documentation issues.

Reporting \& Performance

• Generate and review billing reports related to Medicaid and private insurance claims, denials, and aging.
• Meet productivity and accuracy standards set by the organization.
• Assist with process improvements to reduce denials and improve reimbursement turnaround.

### Required Qualifications

• High school diploma or GED required; associate degree or coursework in healthcare administration or billing preferred.
• Minimum
1–2 years of Medicaid billing experience in a healthcare setting.
• Strong understanding of Medicaid and/or private insurance billing rules, claim forms (CMS\-1500/UB\-04\), and EDI submissions.
• Familiarity with CPT, ICD\-10, and HCPCS coding (coding certification preferred but not required).
• Proficiency with electronic health records (EHR) and practice management systems.
• Excellent attention to detail, organizational skills, and time management.
• Strong written and verbal communication skills.

### Preferred Qualifications

• Experience in behavioral health, mental health, telehealth, or multi\-service outpatient practices.
• Knowledge of state\-specific Medicaid and/or private insurance programs and managed Medicaid plans.
• Certified Professional Biller (CPB) or similar certification.
• Experience working with prior authorizations and referrals.

### Key Competencies

• Accuracy and attention to detail
• Problem\-solving and follow\-through
• Regulatory compliance awareness
• Collaboration and customer service mindset
• Ability to manage high\-volume workloads

### Work Environment

• Office or remote/hybrid setting (depending on organization policy)
• Frequent computer and data entry work
• Interaction with internal staff and external payers

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