Medicaid Collections Billing Specialist

Job Summary

This Work‑from‑Home position requires the employee to reside within 60 miles of an HCA Healthcare hospital (locations include FL, GA, ID, KS, KY, MO, NV, NH, NC, SC, TN, TX, UT, VA). The Medicaid Collections Billing Specialist reviews, edits, submits, and collects both electronic and paper claim submissions for state Medicaid programs and works closely with the Authorization Department.

Responsibilities

• Submit insurance claims to individual insurance companies electronically or via paper form.
• Prepare and submit clean claims to various Medicaid agencies and assigned payers.
• Use coded data to produce and submit claims.
• Analyze remittance advice(s) to ensure accurate posting of rejections, payments, and contractual adjustments in a timely manner.
• Review and appeal unpaid and denied claims.
• Maintain a working knowledge of payer practices and reimbursement methodologies; become a subject‑matter expert in assigned A/R responsibilities.
• Review UB‑1500 claims for accuracy and completeness and obtain missing information as needed for submission.
• Identify and bill secondary or tertiary payors.
• Look up ICD‑10 diagnosis and CPT treatment codes using online services or traditional coding references.
• Maintain appropriate productivity requirements for the role.
• Review medical records related to an inpatient’s clinical presentation and supporting documentation to determine elevated level of care according to claim guidelines per state.
• Submit electronic and paper claims according to Medicaid and department deadlines.
• Collect and enter confidential information into Parallon’s patient management system.
• Collaborate with the clinical team and other resources to sharpen review strategies for stronger ISD criteria documentation, ensuring payor approvals.

Qualifications

• High school diploma or GED (required).
• Medical Billing Certification (required).
• Minimum 4–5 years of experience in a related area (required).
• Medicaid billing experience (preferred).
• 1–2 years acute medical center experience (preferred).
• Knowledge of Medicaid guidelines for inpatient admissions (preferred).

Benefits

• Comprehensive medical, prescription drug, dental, vision, behavioral health, and telemedicine coverage.
• Well‑being support, including free counseling and referral services.
• Paid time off, paid family leave, long‑ and short‑term disability, and various leaves of absence.
• 401(k) plan with 100 % match on 3 %–9 % of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, and retirement readiness tools.
• Tuition assistance, student loan assistance, certification support, dependent scholarships, and partnership with Galen College of Nursing.
• Additional benefits: fertility and family‑building assistance, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection, and consumer discounts.
• Eligibility for benefits may vary by location.