Pay: From $55,000.00 per year
Job description:
Job Summary
The Billing Specialist & Project Analyst is responsible for managing the healthcare (Medicaid) revenue cycle by accurately translating services performed by Community Living of Rhode Island, Inc. (CLRI) into appropriate billing codes. This role ensures timely and accurate reimbursement by submitting claims to BHDDH through Gainwell Technologies, processing payments, reconciling accounts, and resolving claim denials.
In addition, this position supports project planning and analysis by monitoring, evaluating, and reporting on projects throughout their lifecycle to ensure alignment with organizational goals, budgets, and timelines. The role requires strong analytical skills, attention to detail, and effective communication with internal teams and external payers.
Key Responsibilities
Billing & Revenue Cycle Management
- Translate services provided by CLRI into accurate Medicaid billing codes.
- Submit claims to BHDDH via Gainwell Technologies in a timely and compliant manner.
- Process and post payments using Explanation of Benefits (EOBs) and Remittance Advice (RA).
- Reconcile accounts and manage daily deposits.
- Identify, research, and resolve claim denials to ensure timely reimbursement.
- Maintain accuracy and compliance with HIPAA regulations.
- Communicate effectively with participants’ Coordinators, payers, and internal staff regarding billing and payment issues.
Project Analysis & Reporting
- Monitor, evaluate, and support projects throughout the full project lifecycle.
- Ensure project alignment with organizational goals, approved budgets, and established timelines.
- Analyze data and develop reports to support decision-making and operational improvements.
- Maintain accurate project documentation and tracking tools.
- Track and report on key performance indicators (KPIs) to identify trends and opportunities for improvement.
Qualifications
Required
- Experience in healthcare billing, Medicaid billing, or revenue cycle management.
- Knowledge of medical terminology and medical coding, including ICD-10.
- Strong analytical, organizational, and problem-solving skills.
- Excellent written and verbal communication skills.
- Ability to manage multiple priorities with attention to detail and accuracy.
- Proficiency with project management tools and data tracking systems.
Preferred
- Experience working with BHDDH and Gainwell Technologies.
- Background in developmental disabilities or behavioral health services.
- Associate’s or Bachelor’s degree in Healthcare Administration, Business, Finance, or a related field.
Skills & Competencies
- Revenue cycle management
- Data analysis and reporting
- HIPAA compliance
- Project tracking and documentation
- Time management and prioritization
- Collaboration and stakeholder communication
Job Type: Full-time
Benefits:
- 401(k)
- Dental insurance
- Employee discount
- Health insurance
- Life insurance
- Opportunities for advancement
- Paid sick time
- Paid time off
- Vision insurance
Work Location: In person
Pay: $55,157.13 - $60,000.00 per year
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Paid sick time
- Paid time off
Work Location: In person
