HealthCare Billing and Referral Coordinator

HealthCare Billing and Referral Coordinator

The HealthCare Billing and Referral Coordinator is a pivotal new role within Rising Ground's Social Care Network, dedicated to optimizing service delivery for Medicaid members under the 1115 Waiver. This position bridges the gap between clinical support and administrative compliance, ensuring members access timely resources while maintaining the integrity of billing and credentialing frameworks.

What You'll Do

• Serve as the primary administrative point of contact for coordinating and processing a variety of client services for (e.g., nutrition, cooking supplies) for Medicaid-eligible members as defined by the Social Care Network.
• Assist with the administrative intake process, including organizing and verifying documentation to confirm member eligibility for specific support programs under Medicaid guidelines.
• Accurately process and track service authorizations, ensuring all services are properly documented, authorized, and aligned with managed care and state requirements before service delivery.
• Communicate effectively with service providers, Social Care Navigators, and third parties to initiate, modify, or terminate services based on member needs and program requirements.
• Assist in maintaining and updating provider credentialing files, including licenses, certifications, NPI numbers, Medicaid enrollment, and insurance affiliation.
• Support payer contracting activities by collecting, reviewing, and organizing documentations required by Managed Care Organizations, Medicaid, and other insurance entities.
• Ensure all providers and contracted partners meet payer participation standards and compliance criteria prior to onboarding or continued service delivery.
• Track and coordinate re-credentialing and contracting status to ensure readiness for audits and billing submission.
• Serve as an administrative contact with insurance plans to address contracting, credentialing, or roster discrepancies.
• Maintain meticulous, accurate and up-to-date administrative records for all assigned members and their service plans.
• Conduct regular administrative checks for case files to ensure compliance, proper documentation signatures, timely service reviews, and adherence to all regulatory and quality standards.
• Generate routine and ad-hoc reports on service utilization, coordination timelines, contracting status, and compliance metrics for management reviews.
• Function as an integral part of a collaborative team, including HealthCare Navigators and Administrators, to share information, identify service gaps, and ensure seamless continuum for care for members.
• Participate in team meetings, case conferences, and supervision sessions to discuss complex cases and operational improvements.
• Proactively identify and recommend improvements to administrative and credentialing processes to enhance efficiency and effectiveness.
• Clearly communicate service coordination decisions, authorizations, and documentations requirements to all relevant parties.
• Provide professional, timely administrative support to all stakeholders, including members, providers payers and government agencies.

Your Qualifications

• Associate or bachelor's degree in healthcare administration, Public Health, Social Sciences, Business, or a related field.
• Minimum of 2 years in an administrative or coordination role, ideally within healthcare, social services, or a managed care environment.
• Prior experience with insurance payer credentialing or provider contracting is highly preferred.
• Bilingual preferred (English/Spanish)

Supervisory Responsibility:

No

Benefits Offerings includes: 11 Paid Holidays Paid Sick Time Paid Vacation Paid Personal days Insurance Coverage Medical -3 plan options Dental - 2 plan options Vision - 1 plan option

Work Environment:

Office/Field/ Clinic

Position Type/Expected Hours of Work:

This is a full-time position scheduled Monday through Friday, from 9:00 am to 5:00 pm.

Additional Requirements:

• Authorized to work in the U.S.
• Ability to work in-person in New York City (NY) for at least 3 days or more per week.
• Ability to travel to other Rising Ground sites (if required).

Equal Employment Opportunity Statement:

It is the policy of Rising Ground that the Agency wholly complies with equal treatment of all employees and applicants for employment without unlawful discrimination as to an individual's perceived or actual race, creed, color, national origin, alienate, citizenship status, gender, age, disability, marital status, partnership status, sexual orientation, ethnicity, religion, or veteran status in all employment decisions, including but not limited to recruitment, hiring, compensation, training and apprenticeship, promotion, upgrading, demotion, downgrading, transfer, layoff and termination and all other terms and conditions of employment.