Billing & Claims Management
- Prepare, review, and submit Medicaid waiver claims accurately and on time.
- Process billing for New Jersey DDD and Pennsylvania ODP services.
- Review service documentation to ensure billing requirements have been met prior to claim submission.
- Verify authorizations and billing eligibility before claims are submitted.
- Ensure compliance with Medicaid regulations, payer requirements, and agency policies.
- Monitor claim edits and resolve billing exceptions before submission.
- Submit corrected claims and rebill services as necessary.
Accounts Receivable
- Monitor outstanding claims and accounts receivable.
- Investigate denied, rejected, unpaid, or partially paid claims.
- Research billing discrepancies and coordinate timely resolutions.
- Prepare appeals and supporting documentation when appropriate.
- Maintain accurate documentation of billing activities and follow-up efforts.
Payment Posting & Reconciliation
- Post electronic remittance advice (ERA) and manual payments.
- Reconcile payments against submitted claims.
- Identify underpayments, overpayments, and payment variances.
- Assist with monthly reconciliation and revenue reporting.
- Collaborate with Finance to ensure billing accuracy.
Documentation & Compliance
- Ensure billing documentation supports all submitted claims.
- Maintain compliance with Medicaid, HIPAA, and state regulations.
- Stay informed of changes to New Jersey DDD and Pennsylvania ODP billing requirements.
- Assist with internal and external audits.
Collaboration
- Work closely with Clinical, Program Operations, Scheduling, Payroll, Human Resources, and Finance departments.
- Communicate with state agencies, managed care organizations, and payers regarding billing issues.
- Participate in process improvement initiatives to improve billing accuracy and efficiency.
- Provide excellent customer service to internal departments regarding billing inquiries.
Qualifications
Required
- High school diploma or equivalent required; Associate's or Bachelor's degree preferred.
- Minimum of 2 years of medical billing, Medicaid billing, or revenue cycle management experience.
- Strong understanding of:
- Claims processing
- Payment posting
- Accounts receivable
- Denial management
- Excellent organizational and analytical skills.
- Strong written and verbal communication skills.
- High attention to detail and accuracy.
- Ability to prioritize multiple deadlines in a fast-paced environment.
- Proficiency in Microsoft Office, especially Excel.
Preferred
- Experience billing New Jersey Division of Developmental Disabilities (DDD) services.
- Experience billing Pennsylvania Office of Developmental Programs (ODP) services.
- Experience using Therap.
- Experience using PROMISe™.
- Experience using HCSIS.
- Knowledge of Electronic Visit Verification (EVV) requirements.
- Experience billing residential, community-based, day habilitation, behavioral support, employment, respite, and other waiver-funded IDD services.
- Familiarity with Medicaid managed care and fee-for-service billing.
- Experience with ERA processing, appeals, denial resolution, and payment reconciliation.
Technical Skills
Preferred experience with:
- Therap
- PROMISe™
- HCSIS
- Electronic Visit Verification (EVV) platforms
- Medicaid billing software
- Electronic Health Record (EHR) systems
- Clearinghouse claim submission portals
- Microsoft Excel (pivot tables, filtering, reconciliation functions)
Pay: From $20.00 per hour
Benefits:
- 401(k)
- Health insurance
- Paid time off
Education:
- High school or equivalent (Required)
Experience:
- Medical billing: 1 year (Required)
Location:
- East Orange, NJ 07018 (Required)
Work Location: In person
