HealthCare Billing and Referral Coordinator

About the Role

The HealthCare Billing and Referral Coordinator is a pivotal new role within Rising Ground’s Social Care Network, dedicated to optimizing service delivery for Medicaid members under the 1115 Waiver. This position bridges the gap between clinical support and administrative compliance, ensuring members access timely resources while maintaining the integrity of billing and credentialing frameworks.

Responsibilities

• Serve as the primary administrative point of contact for coordinating and processing a variety of client services for (e.g., nutrition, cooking supplies) for Medicaid-eligible members as defined by the Social Care Network.
• Assist with the administrative intake process, including organizing and verifying documentation to confirm member eligibility for specific support programs under Medicaid guidelines.
• Accurately process and track service authorizations, ensuring all services are properly documented, authorized, and aligned with managed care and state requirements before service delivery.
• Communicate effectively with service providers, Social Care Navigators, and third parties to initiate, modify, or terminate services based on member needs and program requirements.
• Assist in maintaining and updating provider credentialing files, including licenses, certifications, NPI numbers, Medicaid enrollment, and insurance affiliation.
• Support payer contracting activities by collecting, reviewing, and organizing documentations required by Managed Care