Billing Specialist Embark Supported Employment Superior, WI Job Details Part-time 15 hours ago Qualifications Accounts receivable optimization Managed care Accounts receivable management Account maintenance Medical insurance coverage verification Payment processing Regulatory compliance in claims processing Practice management software HIPAA Medical billing compliance checks Mid-level Financial issue resolution Medical billing and coding communication with insurance companies Medical denial root cause analysis (RCA) Health information regulatory compliance Medical explanation of benefits reviews Management reporting Medical claims submission Medical billing account reconciliation Insurance provider collaboration Payment reconciliation Insurance claims appeal handling Communication skills Medical claim status updates Invoice dispute resolution Full Job Description Job Summary The MCO Billing Specialist is responsible for the accurate and timely billing, follow-up, and collection of claims submitted to managed care organizations. This role ensures compliance with payer-specific requirements, resolves claim denials and rejections, and supports the organization's revenue cycle by minimizing aging accounts receivable. Responsibilities Prepares, reviews, and submits clean claims to managed care payers via electronic and paper submission Verifies member eligibility, benefits, and authorization requirements prior to claim submission Researches, corrects, and resubmits denied, rejected, or underpaid claims within payer timely-filing limits Posts payments, adjustments, and denials Reconciles remittance advices (ERA/EOB) against expected reimbursement. Monitors accounts receivable aging and conducts proactive follow-up on outstanding claims Maintains current knowledge of payer contracts, fee schedules, and MCO-specific billing rules Communicates with payers, providers, and internal departments to resolve billing discrepancies Documents all account activity accurately in the billing/practice management system. Ensures compliance with HIPAA, payer guidelines, and applicable state and federal regulations Assists with month-end reporting and identifies trends in denials or reimbursement issues Consults with claim clerks at each MCO about any disputed claims and follows up on all bills not processed within the usual claim period. Prepares weekly and monthly reports of MCO billing Competencies Attention to detail, analytical problem-solving, organization, and clear written/verbal communication.