Medicaid Billing and Credentialing Coordinator

Medicaid Billing And Credentialing Coordinator

Effective Date: May 5, 2026 NON-MANAGEMENT JOB DESCRIPTION

Job Title: Medicaid Billing and Credentialing Coordinator

Exempt/Non-exempt: NON-EXEMPT

Immediate Supervisor: Senior Director of Behavioral Health and Clinical Services

Compensation Range: $20 $25

Benefits: Click Here to view LCFS' Full-Time Employee Benefits.

Essential Functions:

1. Primarily responsible for managing Medicaid billing operations, including preparing, reviewing, and submitting claims in compliance with payer requirements, ensuring all services are supported by accurate documentation and appropriate coding.

2. Adhere to the organization's hybrid work expectations, which may include a flexible work arrangement of up to two remote workdays per week following the successful completion of the training period. Hybrid scheduling is optional, contingent upon leadership approval, and requires a minimum of three on-site workdays per week based on departmental and organizational needs.

3. Monitor claims for accuracy, completeness, and timeliness, and investigate, correct, and resubmit denied or unpaid claims as needed.

4. Analyze trends in claim denials and implement proactive solutions to improve reimbursement outcomes.

5. Maintain and apply working knowledge of ICD-10, CPT, and HCPCS coding standards to ensure accurate billing practices.

6. Manage provider and facility enrollment, revalidation, and recredentialing processes with Medicaid and other payers.

7. Ensure accuracy of provider information, including NPIs, TINs, taxonomy codes, service locations, and effective dates.

8. Maintain enrollment records, monitor renewal timelines, and prepare delegated credentialing rosters.

9. Research and resolve billing and enrollment-related issues, including claim denials and payer discrepancies.

10. Serve as a liaison between the organization and insurance payers to address and resolve reimbursement issues.

11. Maintain accurate documentation of billing activity, claim status, and communications in compliance with regulatory requirements.

12. Ensure compliance with Medicaid regulations, HIPAA standards, and organizational policies.

13. Support internal and external audits and reporting related to billing and provider enrollment.

14. Collaborate with clinical, intake, IT, and finance teams to ensure billing readiness and operational efficiency.

15. Identify and implement process improvements to enhance efficiency, accuracy, and overall revenue cycle performance.

16. Participate in ongoing training and stay current on Medicaid billing practices and regulatory updates.

17. Perform other duties as assigned.

Knowledge and Ability Requirements:

Strong knowledge of Medicaid billing processes, regulations, and payer requirements

Proficiency in ICD-10, CPT, and HCPCS coding systems

Understanding of provider enrollment and credentialing processes

Ability to analyze and resolve billing discrepancies and claim denials

Knowledge of HIPAA compliance and healthcare privacy regulations

Strong attention to detail and accuracy in data entry and documentation

Effective communication skills for interacting with internal teams and external payers

Ability to manage multiple priorities and meet deadlines in a fast-paced environment

Education and Experience:

An associate's or bachelor's degree in Healthcare Administration, Business, Finance, or a related field is required. Candidates must have a minimum of 23 years of healthcare billing experience, with a strong emphasis on Medicaid billing. Experience with provider enrollment and credentialing processes is required. Professional certifications such as Certified Professional Biller (CPB), Certified Revenue Cycle Specialist (CRCS), or Certified Medical Reimbursement Specialist (CMRS) are preferred. Prior experience in a behavioral health setting is highly desirable.

Physical Demands and Other Requirements:

To perform this job successfully, an individual must be able to perform the essential duties listed in the job description satisfactorily. While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to sit. The employee is occasionally required to stand; walk; use hands to finger, handle or feel objects, or controls; reach with hands and arms. Capable of operating standard office equipment, including a computer and keyboard, calculator, typical business machines such as a fax machine and copier. The employee must occasionally lift and/or move up to 20-30 pounds. Specific vision abilities required by this job include close vision, distance vision and the ability to adjust focus. The employee is required to have valid driver's license, auto insurance and must be able to safely operate a motor vehicle. The work environment characteristics include a noise level which is usually low to moderate.

Position Responsibilities/Program Execution and Decision Making:

Diversity and Inclusion/ Professionalism: In all aspects of their work presents as a role model to others, behaving in a way which actively supports LCFS as a welcoming community, promotes diversity and inclusion in the workplace and collaborates with others to further equity and dismantle barriers to a more inclusive experience of community. Participates in annual professional development and/or advocacy regarding inclusion.

Ethical Conduct: Follows all ethics policies and procedures related to program execution and decision making as defined by the agency as well as any related professional licensing, regulatory or accrediting body. Maintain confidentiality of client, staff, and agency information. Reports any known or suspected breaches of confidentiality in accordance with policy. Reports possible misconduct or relevant errors/ oversight in a timely manner and responsibly addresses related issues with chain of command.

Communication/ Interpersonal Skills: Consistently conveys clear, accurate, timely, and respectful communication appropriate for the situation. Informs appropriate management staff when incident occurs or a crisis situation. Maintains professional boundaries with clients/residents, staff, interns, volunteers, and vendors. Able to successfully share skills and concepts with others and works effectively with others under time and environmental pressures.

Safety and Agency Resource Utilization: Demonstrates sound judgement and foresight in safety awareness and in daily work. Notifies, in a timely manner, the supervisory chain of any incidents or circumstances that need attention. Report all suspicions or allegations of abuse immediately to their supervisor. Ensures appropriate utilization of materials and resources and minimizes waste.

Other Responsibilities: All other tasks and responsibilities as assigned.

LCFS IS AN EQUAL OPPORTUNITY EMPLOYER

Lutheran Child and Family Services of Illinois