EDI Billing and Medicaid Claims Specialist

Job Summary:
We are seeking a detail-oriented and self-motivated EDI Billing & Medicaid Claims Specialist to support our revenue cycle operations. This role requires expertise in 837 EDI file processing, Medicaid billing portals, and EMR systems to ensure accurate and timely claim submissions. The ideal candidate will have strong problem-solving and critical-thinking skills, the ability to analyze denial codes, and the initiative to resubmit and reconcile claims efficiently.

This is a remote position requiring independent work with minimal supervision. The candidate must be highly organized, meet claim resolution timelines and denial reduction targets, and demonstrate strong Excel skills for data analysis and reporting.

Key Responsibilities:

• Submit, process, and troubleshoot EDI claims (837, 277, 276, 835, 270, 271 transactions) for Medicaid and Managed Care Organizations.
• Conduct eligibility checks and ensure provider enrollment with Medicaid, MMIS, and Managed Care Organizations.
• Understand procedure billing and diagnosis codes, identify denial reasons, and take corrective action.
• Resubmit failed claims and proactively follow up to ensure resolution.
• Manage the reconciliation and rebilling process to maintain revenue cycle efficiency.
• Prepare regular billing reports for management review, compiling, analyzing, and evaluating billing data.
• Ensure compliance with HIPAA, state, and federal tax and regulatory authorities.
• Provide support for ad-hoc projects initiated by management.
• Work closely with clients, partners, and internal teams to resolve FMS-related billing issues.
• Develop strong working relationships with providers and Medicaid payers.
• Provide exceptional customer service and maintain professionalism in all interactions.

Required Qualifications:

• Minimum 3 years of experience in Medicaid billing, EDI processing, and revenue cycle management.
• Proficiency in 837 claim submission and reconciliation processes.
• Strong knowledge of Medicaid portals, MMIS, and Managed Care Organization billing requirements.
• Understanding of denial codes, rebilling, and revenue cycle workflows.
• Advanced Excel skills, including VLOOKUPs, pivot tables, and conditional formulas (e.g., SUMIF, COUNTIF).
• Ability to analyze complex data, think critically, and solve problems independently.
• Self-starter with excellent organizational and time-management skills.
• Strong attention to detail and ability to meet claim resolution timelines.
• Experience working remotely with minimal supervision.

Preferred Qualifications:

• Degree or certification in healthcare administration, accounting, or a related field.
• Experience with multiple Medicaid billing platforms and EMR systems.

This position offers the flexibility of remote work while requiring a proactive and results-driven approach. If you have the skills to navigate the complexities of Medicaid billing and EDI claims, we encourage you to apply!

Company benefits designed for you:

• Generous Paid time off.
• Quarterly/Annual bonus potential.
• Retirement Savings: We will support you as you save for your future.
• Career Growth Opportunities: We help you thrive, so together, we can grow. We provide opportunities to advance your career with a vast portfolio of businesses and a global footprint.
• Paid Training: Earn while you learn, and continue to grow with access to internal and external learning opportunities.
• Great Work Environment: We are proud of our company culture of collaboration and the recognition we’ve received for our diversity efforts.