Medical Billing Specialist - Medicare Advantage

Medical Billing Specialist - Medicare AdvantageAdmin Building Fulltime In Person (Monday - Friday 8:00 am - 4:30 pm) About UsHealth Partners of Western Ohio is an independent, non-profit and community-directed organization. We serve low-income areas and places without access to care. We're led by a volunteer Board of Directors. Most of our board members are also patients. Our Mission is to eliminate gaps in health outcomes for all members of our community by providing access to quality, affordable, preventive and primary health care. SUMMARY:POSITION PURPOSE With knowledge of FQHC billing requirements, the Accounts Receivable Specialist prepares, submits, and follows up on insurance claims to Medicare Advantage Payers to support an efficient and effective revenue cycle. ESSENTIAL FUNCTIONS AND BASIC DUTIES:Review insurance coverage and patient demographic information to ensure accuracy and completeness prior to billingPrepare, review, submit, and track insurance claims to Medicare Advantage payers in accordance with FQHC, state, and federal billing requirementsProcess insurance reimbursements and reconcile remittance reports with payments receivedMonitor accounts receivable aging and actively follow up on unpaid or underpaid Medicare Advantage Claims.Identify Medicare Advantage denial trends, systemic payment issues, and eligibility discrepanciesResolve payment credits and overpayments through claim corrections, refunds, or payer coordination in compliance with CMS and federal regulationsMaintain current knowledge of FQHC billing rules, CPT, CDT, and ICD-10-CM coding requirementsRespond professionally and knowledgeably to inquiries from patients, providers, and insurance representativesCoordinate with internal teams (including Medicare, Medicaid, Managed Medicaid, and third-party insurance teams) to resolve shared or complex claim issuesReview and process incoming correspondence related to claims and paymentsMaintain organized electronic claim, payment, and correspondence records to support audits and reportingSafeguard patient information in accordance with HIPAA and health center confidentiality policiesPerform other job-related duties as assigned QUALIFICATIONSEDUCATION/CERTIFICATION: High School Degree or GED Required. REQUIRED KNOWLEDGE: Successful completion of in-house training. EXPERIENCE REQUIRED: Experience with healthcare billing preferred. SKILLS/ABILITIES:Working knowledge of multiple insurance types, including Medicaid, Medicare, and commercial payersUnderstanding of basic medical and billing terminologyAbility to manage time effectively and prioritize tasks in a deadline-driven environmentStrong analytical skills with the ability to critically evaluate available information and make informed decisionsModerate technical proficiency with the ability to work simultaneously across multiple systems and platforms, including Excel, practice management systems, and Microsoft TeamsWHAT WE OFFER:Starting pay $21.60 and goes up based on experience in Federally Qualified Health Center billing Paid Time Off (PTO) - Accrued per payInsurance (Medical, Dental, Vision, Life and Disability)Paid Holidays - 7 paid holidays403b Retirement with up to 8% match (starts at 3% and increases with time of service at HPWO)Annual Reviews and IncreasesEmployee Assistance ProgramReferral Bonus - Earn more by expanding our teamTraining OpportunitiesEligible to apply for the Emerging Leaders Program after 1 year of service