BG Healthcare Services is seeking an experienced Medicaid Billing & Accounts Receivable Specialist with strong knowledge of Virginia Medicaid, managed care billing, home- and community-based services, and personal care billing. This is not an entry-level billing position. We need someone who can independently manage claims from billing-ready handoff through final payer disposition and payment, while also helping BG work through historical unpaid, denied, rejected, underpaid, and unresolved claims. The ideal candidate understands how authorizations, EVV, service units/hours, claims, remittances, denials, recoupments, and payments connect and can follow an issue through resolution rather than simply reporting that a claim did not pay. Absolutely. I would post it more like this—clear about what the biller owns, what Operations/Monica owns, and strong enough to attract somebody who can actually work claims rather than just submit them. Medicaid Billing & Accounts Receivable Specialist BG Healthcare Services | Falls Church, VA Part-Time | In-Person/Hybrid | Compensation Based on Experience BG Healthcare Services is seeking an experienced Medicaid Billing & Accounts Receivable Specialist with strong knowledge of Virginia Medicaid, managed care billing, home- and community-based services, and personal care billing. This is not an entry-level billing position. We need someone who can independently manage claims from billing-ready handoff through final payer disposition and payment, while also helping BG work through historical unpaid, denied, rejected, underpaid, and unresolved claims. The ideal candidate understands how authorizations, EVV, service units/hours, claims, remittances, denials, recoupments, and payments connect and can follow an issue through resolution rather than simply reporting that a claim did not pay. Key Responsibilities Submit accurate and timely Virginia Medicaid and Cardinal Care managed care claims. Work with BG's Medicaid managed care payers, including Aetna Better Health, Anthem HealthKeepers Plus, Humana Healthy Horizons, Sentara Health Plans, and UnitedHealthcare Community Plan, as applicable. Confirm claims were successfully transmitted, accepted by the appropriate clearinghouse/payer, and received for adjudication. Monitor claims through final disposition and payment. Work existing aged A/R, unpaid claims, denied claims, rejected claims, underpayments, recoupments, and unresolved historical balances. Determine the root cause of unpaid or incorrectly paid claims and pursue the appropriate correction, corrected claim, reconsideration, resubmission, appeal, or payer follow-up. Reconcile authorized hours/units, EVV records, billed units, paid units, and remaining authorization to identify reimbursement discrepancies. Identify duplicate billing, authorization gaps, unit discrepancies, timely-filing concerns, overutilization, underbilling, and other reimbursement risks. Review EVV records for billing readiness and identify missing or incorrect visits, punches, service codes, units, or supporting documentation. Coordinate needed operational corrections with the Office Manager when a billing issue originates from scheduling, authorization, EVV, documentation, or service delivery. Work within

DMAS/MES/PRSS, EVV

systems, clearinghouses, and individual MCO provider portals, as applicable. Review and reconcile ERA/835 remittances, claim adjustments, denials, recoupments, and payment activity. Ensure paid, partially paid, denied, recouped, and unresolved claims are accurately reflected in A/R. Maintain an accurate and supportable collectible A/R aging report rather than carrying balances that have already been paid, duplicated, unsupported, or determined noncollectible. Maintain claim-level documentation showing submission date, payer status, denial or adjustment reason, follow-up activity, corrective action, payment disposition, and remaining balance. Assist with payer audits, claims research, authorization verification, appeals, and supporting documentation when needed. Maintain an organized claims inventory and independently follow open issues through resolution. Escalate issues requiring management decisions with a clear explanation of the problem, research completed, financial impact, and recommended next action. Weekly Reporting Provide management with concise weekly reporting that includes: Claims submitted Billable services not yet submitted Payments received Collectible A/R Denied and rejected claims Underpayments and partial payments Recoupments or payment adjustments Aged claims requiring follow-up Dollars recovered from historical A/R Outstanding barriers to collection Items requiring management action The Billing Specialist will work closely with the Office Manager, who is responsible for operational billing readiness, including authorization tracking, scheduling, EVV completion, caregiver-hour reconciliation, and operational corrections. The Billing Specialist is responsible for claim submission, payer follow-up, adjudication, payment reconciliation, A/R, denial management, and revenue recovery. Required Qualifications Minimum 2 years of healthcare billing, Medicaid billing, accounts receivable, or revenue-cycle experience. Demonstrated experience with Virginia Medicaid/DMAS billing. Experience working with Virginia Medicaid managed care plans and payer/provider portals. Strong experience resolving denied, rejected, unpaid, partially paid, and aged claims. Ability to read and interpret remittance advice and determine why a claim did or did not pay. Understanding of Medicaid service authorizations, units/hours, eligibility, timely filing, corrected claims, reconsiderations, and appeals. Experience reconciling claims to remittance and payment activity. Strong Excel, reporting, documentation, and organizational skills. Ability to independently manage a claims inventory and follow issues through final resolution. Strong attention to detail and ability to identify discrepancies between authorization, service delivery, billing, and payment. Strongly Preferred Experience with personal care, home care, HCBS, or Virginia waiver services. Experience with MyEVV, HHAeXchange, or comparable EVV platforms. Familiarity with DMAS/MES/PRSS and Virginia Medicaid provider systems. Experience recovering aged or previously unresolved Medicaid/MCO receivables. Experience with authorization reconciliation, payer recoupments, corrected claims, reconsiderations, and appeals. Experience reconciling EVV/service records to claims and ERA/835 payments. Compensation Compensation will be based on experience and demonstrated expertise in Virginia Medicaid billing, managed care A/R, denial resolution, and revenue recovery.

Pay:

$17.00 - $22.00 per hour Expected hours: 15.0 - 25.0 per week

Benefits:

Retirement plan

Work Location:

In person