Medicaid Billing – Revenue Cycle Specialist

The Medicaid Billing Specialist is responsible for the timely and accurate preparation, submission, reconciliation, and follow-up of Medicaid claims for Goodwill's human services programs. This position works closely with program operations, clinical staff, finance, and contract management to ensure billing complies with Medicaid regulations, funder requirements, and agency policies.

The ideal candidate has hands-on experience using Foothold AWARDS and the MILLIN Medicaid billing system, with a strong understanding of Medicaid documentation requirements, claim processing, denial management, and revenue cycle best practices.

Essential Duties and Responsibilities

Prepare, review, and submit Medicaid claims accurately and timely.
Utilize Foothold AWARDS to verify service documentation, authorizations, attendance, and billing readiness.
Process Medicaid claims through the MILLIN and eMedNY billing platforms.
Review billing reports to identify missing documentation, billing exceptions, and claim errors.
Research, resolve, and resubmit denied or rejected claims.
Monitor claim status and payment activity through Medicaid portals and billing systems.
Reconcile payments received against submitted claims and investigate payment discrepancies.
Work collaboratively with program staff to ensure documentation meets Medicaid billing standards.
Monitor authorization balances and ensure services are billed within approved limits.
Maintain billing logs, aging reports, and accounts receivable tracking.
Assist with month-end billing close and revenue reconciliation.
Prepare reports for Finance and Grants & Contracts leadership regarding billing performance, collections, and outstanding claims.
Stay current on Medicaid billing regulations, provider manual updates, and payer requirements.
Support internal and external audits by providing requested billing documentation.
Recommend process improvements to strengthen billing accuracy and maximize reimbursement.

Qualifications

Associate's or bachelor’s degree in accounting, Finance, Healthcare Administration, Business Administration, or related field preferred.
Minimum of 3 years of Medicaid billing experience in a behavioral health, workforce development, or human services organization.
Required experience with eMedNY.
Required experience with Foothold AWARDS.
Required experience with the MILLIN Medicaid billing system.
Knowledge of New York Medicaid billing regulations and documentation requirements.
Experience working with managed care organizations and fee-for-service Medicaid billing preferred.
Strong understanding of revenue cycle management.
Excellent analytical, organizational, and problem-solving skills.
Proficient in Microsoft Excel, including pivot tables, VLOOKUP/XLOOKUP, and reporting.
Ability to manage multiple priorities while meeting strict billing deadlines.
Excellent written and verbal communication skills.
Preferred Qualifications

Experience working with nonprofit organizations.
Experience billing OPWDD, OMH, OASAS, ACCES-VR, or other New York State-funded programs.
Experience supporting fiscal audits and contract compliance.
Knowledge of electronic health record (EHR) systems and billing interfaces.
Key Competencies

Attention to Detail
Medicaid Billing Expertise
Revenue Cycle Management
Claims Resolution
Financial Reconciliation
Compliance
Data Analysis
Time Management
Collaboration
Customer Service
Confidentiality
Performance Measures

Timely submission of Medicaid claims.
Clean claim rate.
Denial rate and turnaround time for resolution.
Days in Accounts Receivable.
Accuracy of billing reconciliations.
Compliance with Medicaid regulations and audit requirements.
Achievement of monthly billing deadlines.