HMO Medicaid Biller

Job Title: HMO Medicaid Biller

Job Description:

We are seeking a detail-oriented HMO Medicaid Biller to join our long-term care billing team. The ideal candidate will be responsible for accurately preparing, submitting, and following up on claims to HMO and Medicaid insurance plans. This role requires strong knowledge of insurance guidelines, medical billing procedures, and Medicaid/HMO policies to ensure timely reimbursement and compliance.

Responsibilities:

• Submit and track claims to HMO and Medicaid payers
• Review EOBs and resolve claim denials or rejections
• Monitor and follow up on unpaid or denied claims
• Verify resident eligibility, authorizations, and coverage
• Process adjustments, appeals, and resubmissions as needed
• Post payments and reconcile resident accounts
• Communicate with insurance providers, residents, and families regarding billing issues
• Verify patient eligibility and coverage
• Ensure compliance with federal, state, and payer regulations
• Communicate with insurance companies, providers, and patients regarding billing inquiries
• Maintain accurate billing records and reports
  
  
  

Qualifications:

• 5 years of experience in medical billing (HMO/Medicaid preferred)
• Knowledge of CPT, ICD-10, and HCPCS coding
• Familiarity with electronic billing systems and clearinghouses
• Strong attention to detail and problem-solving skills
• Excellent communication and organizational abilities