Revenue Cycle Biller

Revenue Cycle Biller

The Revenue Biller is responsible for managing and processing Medicaid and third-party insurance claims for services delivered across Illinois and Ohio operations. This role ensures accurate coding, timely submission, reimbursement tracking, and resolution of claim discrepancies to support optimal revenue cycle performance.

The Revenue Biller plays a critical role in maintaining compliance with state Medicaid regulations, improving reimbursement efficiency, and safeguarding organizational revenue integrity.

Key Responsibilities:

• Collect and process Ohio and Illinois Medicaid reimbursements by gathering, coding, and transmitting client service information accurately and timely.
• Review client records to verify proper Medicaid coding, service authorization, and documentation completeness
• Submit electronic claims through designated Medicaid portals and billing platforms.
• Verify accuracy of Medicaid coding prior to submission to ensure payment integrity.
• Monitor claim status and ensure timely adjudication within standard processing periods.
• Investigate and resolve billing discrepancies through detailed research and data analysis.
• Adjust patient bills based on remittance advice and Medicaid correspondence.
• Resolve denied or disputed claims by consulting with Medicaid claims representatives and providing additional documentation as required.
• Follow up on unpaid or delayed claims within standard claim aging timelines.
• Maintain detailed documentation of claim follow-up and resolution efforts.
• Analyze billing records for completeness and accuracy; obtain clarifications when needed.
• Prepare monthly reports summarizing:
• Medicaid billings submitted
• Adjustments and write-offs
• Payments received
• Outstanding receivables
• Track reimbursement trends and flag revenue risks to leadership.
• Assist in internal audits related to Medicaid billing compliance.
• Collect and bill commercial insurance carriers and other third-party payers as applicable.
• Verify eligibility and coverage prior to billing.
• Ensure coordination of benefits when multiple payers are involved.
• Stay current on Illinois and Ohio Medicaid billing regulations, coding updates, and reimbursement requirements.
• Participate in professional development opportunities related to Medicaid billing and revenue cycle management.
• Maintain confidentiality and compliance with HIPAA and organizational standards.

Competencies:

• Revenue integrity mindset
• Regulatory compliance awareness
• Analytical problem-solving
• Detail orientation
• Accountability & follow-through
• Multi-state operational knowledge

Work Setting:

• Onsite Office Setting
• May require coordination with multi-state teams
• Standard business hours with occasional deadline-driven demands

Qualifications:

• Bachelor's degree in Healthcare Administration, Business, Finance, or related field required
• Billing/Coding Certification desired.
• Minimum 23 years of Medicaid billing experience (Illinois and/or Ohio preferred)
• Experience working in behavioral health, community mental health, or social services billing strongly preferred
• Experience with electronic health record (EHR) systems and Medicaid portals required

What We Offer:

• Competitive salary and benefits package.
• A supportive and dynamic work environment committed to social impact.
• Opportunities for professional development and growth.