Medical Billing & Customer Service Specialist

Job Description

Job Description

Medicaid Billing & Customer Service Specialist

Reports to: CEO
Location: In-Person, Westfield, NJ
Department: Operations/Finance
Organization: 40 Dreams Catering

Role Overview

The Medicaid Billing & Customer Service Specialist is responsible for managing all aspects of Medicaid medical billing, claims resolution, and customer service for 40 Dreams Catering. This mid-level role ensures accurate, timely billing, reduces claim denials, resolves back claims, and establishes efficient billing workflows. The Specialist will serve as the primary liaison between 40 Dreams Catering, Medicaid, insurance providers, and clients, delivering excellent service while upholding 40 Dreams’ Excellence in Action values.

This role is critical to ensuring the financial health of 40 Dreams Catering and supporting our mission to improve lives by delivering fresh, healthy meals to seniors.

Key Responsibilities

Billing & Claims Management

●       Submit Medicaid claims accurately and in compliance with state/federal requirements.

●       Track, monitor, and reconcile outstanding claims; ensure timely payment posting.

●       Research, resolve, and resubmit denied or delayed claims.

●       Maintain detailed billing records and prepare reports for leadership review.

Workflow & Process Development

●       Establish efficient billing workflows and SOPs to minimize errors and improve turnaround times.

●       Continuously identify and implement process improvements to reduce denials and maximize reimbursement.

●       Partner with the CEO to refine billing KPIs and reporting cadence.

Customer & Partner Interface

●       Serve as primary contact for client billing inquiries, explaining Medicaid benefits and resolving concerns with patience and professionalism.

●       Communicate directly with Medicaid offices, insurance companies, and other payers to resolve discrepancies or questions.

●       Collaborate with internal teams (Operations, Kitchen, Drivers) to ensure accurate service records align with billing.

Compliance & Quality Assurance

●       Stay current with Medicaid regulations, billing codes, and reimbursement policies.

●       Ensure all billing practices comply with HIPAA and Medicaid requirements.

●       Conduct periodic audits of claims to identify gaps or risks.

Collaboration & Reporting

●       Work closely with the CEO to provide weekly updates on billing status, collections, and outstanding claims.

●       Collaborate with Operations and Finance to align billing outcomes with company goals.

●       Track and present billing KPIs (see below).

Key Performance Indicators (KPIs)

●       Claim Submission Accuracy: 98% or higher first-pass acceptance rate.

●       Denial Rate: Less than 5% of claims denied or delayed.

●       Back Claim Resolution: Clear backlog of outstanding claims within 90 days of hire; maintain <30 days average outstanding claims thereafter.

●       Payment Cycle Time: Average Medicaid reimbursement received within 30 days.

●       Customer Satisfaction: ≥90% resolution satisfaction rate from clients regarding billing inquiries.

●       Workflow Efficiency: Implement and document standard billing workflows within 60 days.

Qualifications & Skills

●       Education/Experience:

o   Minimum 3 years of Medicaid/medical billing experience (preferred in food/nutrition, home health, or healthcare services).

o   Experience working directly with Medicaid systems and resolving denied claims.

●       Technical Skills:

o   Proficiency in Medicaid billing systems, EHRs, Availity, EZ Claims, or equivalent billing platforms.

o   Strong Excel, Google Sheets, and reporting skills.

o   Proficiency with Microsoft Office and Asana

●       Core Competencies:

o   Detail-oriented with strong organizational skills.

o   Effective communicator—able to explain billing clearly to seniors, families, and payers.

o   Problem-solver with ability to manage competing priorities.

o   Bilingual English/Spanish preferred

●       Values Alignment: Must embody 40 Dreams Catering’s Excellence in Action values: Respect, Excellence Through Care, Teamwork, Kindness, and Growth.

●       Other Requirements: Ability to work in-person at the Westfield, NJ office; current driver license, must pass a background check, and maintain HIPAA compliance.

Why Join 40 Dreams Catering?

At 40 Dreams Catering , we believe food has the power to ignite healthy, thriving lives. You’ll join a mission-driven organization dedicated to improving the lives of seniors through fresh, healthy meals and exceptional service. As a key member of our team, you’ll have a direct impact on both our financial health and the well-being of the clients we serve.

40 Dreams Catering is a home-delivered meal service dedicated to providing nutritious meals, excellent customer service, and chef experiences to senior citizens and disabled adults in New Jersey. Meals can be purchased directly, through health insurance programs for eligible participants (MLTSS), or through chef-prepared meal delivery programs.

Company Description

40 Dreams Catering is a home-delivered meal service dedicated to providing nutritious meals, excellent customer service, and chef experiences to senior citizens and disabled adults in New Jersey. Meals can be purchased directly, through health insurance programs for eligible participants (MLTSS), or through chef-prepared meal delivery programs.