General Role Description

The Medical Billing Coordinator is responsible for the management of Medicaid and Managed Care Organization (MCO) billing activities for designated agency programs. This position oversees claim submission, reimbursement tracking, denial management, payment reconciliation, and accounts receivable follow-up to ensure timely and accurate revenue collection.

The Medical Billing Coordinator serves as the agency's primary resource for payer-related billing matters, including eligibility issues, authorization requirements, rate changes, retroactive adjustments, prorated billing calculations, and reimbursement discrepancies. Working closely with Finance, Program, and external payer representatives, this position helps maximize reimbursement opportunities, strengthen billing processes, and support future expansion of billable services.

Essential Duties and Responsibilities

• Accurately prepares, reviews, and submits weekly electronic medical claims to third party payers in accordance with established billing schedules and payer requirements.

• Monitors claim status throughout the billing process.

• Investigates and resolves denied, suspended, underpaid, or rejected claims.

• Maintains billing records and supporting documentation to ensure compliance with payer, regulatory, and agency requirements.

• Reviews admissions, discharges, transfers, authorizations, and census information to ensure accurate billing.

• Reviews remittance advice and payment reports to ensure accurate reimbursement and identify collection opportunities.

• Calculates and processes billing adjustments related to rate changes, retroactive eligibility determinations, payer updates, and prorated service periods.

• Performs ongoing accounts receivable follow-up activities to maximize collections and reduce outstanding balances.

• Identifies reimbursement opportunities resulting from retroactive approvals, rate adjustments, claim corrections, payer processing errors, or other billing discrepancies.

• Maintains knowledge of Medicaid, Managed Care Organization (MCO), and payer billing requirements affecting agency services.

• Establishes and maintains relationships with billing software representatives to solve technical issues.

• Coordinates with other key external and internal staff to obtain necessary solutions to billing issues.

• Implements billing and reporting processes within medical billing software.

• Creates medical billing software reports to monitor managed care / insurer approvals and payment process.

• Generates reports for the Finance department for data entry of managed care / insurer revenue and payments into QuickBooks.

• Provides assistance and backup for other members of the Finance department as needed.

• Associate’s degree in Medical Billing and Coding, Healthcare Administration, Business, Accounting, or a related field preferred. Equivalent combination of education and experience will be considered. Three to five years of experience in medical billing, managed care billing, Medicaid billing, behavioral health billing, or related reimbursement functions.

• Experience working with claim denials, appeals, accounts receivable follow-up, payment reconciliation, and reimbursement analysis.

• Knowledge of Medicaid and Managed Care billing requirements is strongly preferred.

• Must have a valid New York State driver’s license and reliable automobile.