Accounts Receivable & Medical Billing Specialist

Job Description

Job Description

Position Summary

Prolific Community Resources is seeking a detail-oriented and organized Accounts Receivable & Medical Billing Specialist to manage Medicaid and insurance billing, accounts receivable functions, claim follow-up, payment posting, and related financial processes. This position plays a critical role in ensuring accurate reimbursement for behavioral health and developmental disability services while maintaining compliance with Medicaid regulations and agency policies.

The ideal candidate will have experience in medical billing, accounts receivable management, and behavioral health services. Experience with NC Medicaid Innovations Waiver services and Representative Payee functions is highly preferred.

Essential Duties and Responsibilities

Medical Billing & Claims Management

• Prepare, submit, and track Medicaid and insurance claims.
• Review billing documentation for accuracy and completeness.
• Correct and resubmit denied or rejected claims.
• Monitor claim status and follow up on unpaid claims.
• Ensure compliance with Medicaid, payer, and agency billing requirements.
• Reconcile billing records with payments received.

Accounts Receivable

• Monitor outstanding receivables and aging reports.
• Investigate and resolve payment discrepancies.
• Post payments, adjustments, and remittances accurately.
• Generate and maintain AR reports for management review.
• Follow up with payers, providers, and stakeholders regarding outstanding balances.

Financial Administration

• Maintain accurate billing and financial records.
• Assist with monthly financial reconciliation activities.
• Support audits and documentation requests.
• Collaborate with provider agencies and internal staff regarding billing issues.
• Ensure confidentiality and HIPAA compliance in all financial activities.

Representative Payee Support (Preferred)

• Assist with monitoring member funds and account balances.
• Support room and board tracking, member allowance distributions, and financial reporting.
• Maintain documentation related to Representative Payee activities.

Minimum Qualifications

Required

• High School Diploma or GED.
• Minimum 2 years of medical billing experience in a healthcare, behavioral health, or medical office setting.
• Strong knowledge of accounts receivable processes.
• Experience working with electronic health records (EHR) and billing systems.
• Proficiency in Microsoft Office, especially Excel.
• Strong organizational skills and attention to detail.
• Ability to manage multiple priorities and meet deadlines.

Preferred

• 2 years of experience working in the mental health, behavioral health, or developmental disability field.
• Experience billing NC Medicaid services.
• Familiarity with Medicaid Innovations Waiver services.
• Experience with Representative Payee or fiduciary financial management.
• Knowledge of healthcare coding and billing procedures.
• Experience with electronic claims submission and denial management.

Skills and Competencies

• Excellent analytical and problem-solving skills.
• Strong communication and customer service abilities.
• Ability to maintain confidentiality and professionalism.
• Detail-oriented with a high level of accuracy.
• Ability to work independently and collaboratively.

Compensation & Benefits

• Competitive salary based on experience.
• Paid time off.
• Professional development opportunities.
• Supportive team environment.
• Opportunities for growth within the organization.