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 overpayments 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
EDUCATION/CERTIFICATION: High School Degree or GED Required.
