Medicaid Accounts Receivable Specialist

Purpose:

The Medicaid Accounts Receivable Specialist ensures accurate, timely billing and reimbursement — both general AR and Medicaid-specific — for residents across the portfolio. This role serves as the go-to expert on Medicaid processes while handling day-to-day AR duties, partnering closely with community business office staff and leadership to maintain compliance, protect revenue, and deliver excellent customer service.

Essential Job Functions:

Accounts Receivable

• Maintain daily communication with Business Office Managers (BOMs) and Executive Directors to resolve AR needs and account inquiries, providing timely, professional service (including across shared email inboxes).
• Manage the monthly billing and month-end cycle: process AR forms, verify deposits, run and validate billing, and process resident settlements.
• Review aging reports and occupancy activity to identify and resolve outstanding account issues.
• Enter payment reports, returned payments, and related adjustments; process ACH payments, resident refunds, and referral payments per company policy.
• Collaborate with community leadership and internal departments to maintain AR compliance and account accuracy.

Medicaid Billing & Reimbursement

• Support Medicaid authorization intake, verification, and documentation (electronic and community historical files); verify and enter Medicaid rates with Business Office Directors.
• Manage monthly Medicaid billing, including standardized adjustment and LOA credit methodology, and coordinate claims filing after month-end (e.g., via Sunbound), cross-checked against leaves of absence.
• Post Medicaid payments from remittance advices to the correct month of service, track overpayments as credits, and retain remittance documentation.
• Research and resolve Medicaid account discrepancies and denials, including full account audits when payments don't match billed totals; track denials, appeals, and adjustments.
• Lead scheduled Medicaid account audits (e.g., quarterly) and monitor aging of Medicaid balances over 90 days, escalating as needed.
• Verify resident Medicaid eligibility and ensure compliance with Medicaid regulations, coding guidelines, and state-specific payer requirements across all applicable states.
• Prepare reports on Medicaid reimbursement trends, denials, aging, and payment performance for leadership.
• Deliver onboarding and ongoing training to BOMs and EDs on AR and Medicaid processes, systems, and best practices.

Minimum Eligibility Requirements

• Strong knowledge of Medicaid regulations, billing, and reimbursement processes; multi-state experience a plus.
• Experience with Medicaid/healthcare billing systems and claims software; knowledge of basic accounting.
• Proficiency in MS Office (Excel, Word, Outlook).
• Strong interpersonal, oral, and written communication skills — regularly liaises with BOMs, EDs, and state agencies.
• Excellent attention to detail, analytical, and organizational skills.
• Self-directed, results-oriented, and able to work well under pressure to meet deadlines.
• Sound judgment, integrity, and a proactive, energetic approach to new challenges.