Revenue Cycle Specialist - Prior Authorization and Claims

1 month ago
Full-time
Mid Level
Operations

Grace Community Care Inc. / Grace Community Care and Day Habilitation

A New Jersey human-services and disability-services provider offering community-based supports, occupational therapy, housing supports, individual support, education and training, and related services for adults with intellectual and developmental disabilities and other mental, physical, and emotional challenges.

Human services, disability services, day habilitation, community-based care

Description

  • Prepare, review, and submit insurance claims for Medicaid and other payers.
  • Verify ICD-10, CPT, and HCPCS codes and ensure claim forms are completed accurately.
  • Review supporting documentation before claim submission and track claim status after submission.
  • Investigate denied or rejected claims and prepare appeal documentation.
  • Correct coding or documentation errors and resubmit claims to payers.
  • Follow up with payers on outstanding claims, denials, and appeals.
  • Maintain organized billing records and claim documentation.
  • Ensure documentation meets payer, Medicaid, HIPAA, and healthcare regulatory requirements.
  • Track accounts receivable and aging claims to identify billing delays and denial patterns.
  • Improve billing workflows to maximize reimbursement.

Requirements

  • Strong knowledge of ICD-10 coding, CPT/HCPCS codes, CMS claim forms, and medical billing workflows.
  • Experience handling claim denials and appeals.
  • Excellent organizational and documentation skills.
  • High level of accuracy and attention to detail.
  • Ability to manage multiple claims and deadlines.
  • Experience with Medicaid billing, including Medicaid waiver services, preferred.
  • Experience with EVV systems, preferably Therap.
  • Healthcare provider agency experience preferred.
  • Familiarity with New Jersey Medicaid billing rules preferred.
  • Full-time availability.

Benefits

  • Health care plan including medical, dental, and vision coverage.
  • Retirement plan with 401(k) and IRA options.
  • Paid time off, including vacation, sick leave, and public holidays.
  • Hourly pay of $21.56 to $24.57 per hour.

Interested in this position?

Apply directly on the company website

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