Medical Insurance Billing Specialist

TITLE: Medical Insurance Billing Specialist DATE WRITTEN: 2/2026

DEPARTMENT: Children and Family Services SUPERVISED BY: AVP of Children and Family

SUPERVISES: N/A STATUS: Part Time

Mission Contribution: To ensure effective integration of Goodwill’s mission through the Children and Family Services Department.

Function: This position is responsible for managing all billing functions related to Medicaid and private insurance for the Autism Diagnostic Clinic and expanding programs. This role ensures accurate and timely claim submission, provider enrollment, participant eligibility verification, and monthly reporting to appropriate departments.

Essential Functions: (must be able to perform these functions, with or without a reasonable accommodation).

1. Prepare, submit, and track claims for Medicaid and private insurance companies for all programs.

2. Review clinical documentation for accuracy and completeness prior to billing.

3. Follow up on unpaid or denied claims and complete corrections, appeals, or resubmissions.

4. Reconcile payments, remittance statements, and Explanation of Benefits (EOBs).

5. Ensure all providers/ therapists are correctly enrolled and credentialed with each insurance company, including Medicaid and all contracted private insurers.

6. Maintain up-to=date knowledge of Medicaid regulations, prior authorization requirements, and payer-specific billing rules.

7. Ensure compliance with HIPAA, state Medicaid guidelines, and organizational policies.

8. Verify client insurance eligibility and benefits for services.

9. Obtain and track prior authorizations when required.

10. Communicate coverage issues or authorization concerns to clinic staff.

11. Report monthly remittance to appropriate departments.

12. Maintain organized internal billing logs and performance tracking.

13. Communicate professionally with families, payers, and vendors as needed.

14. Representing and promoting Goodwill through involvement in community activities.

15. Acting as a positive role model for employees and students.

16. Observing safety procedures and ensuring compliance by employees and students.

17. Ensuring regular attendance as outlined in Goodwill policy.

18. Other duties as assigned.

Skills, knowledge and abilities: (these are required to enable job holder to perform the essential functions of the job).

1. Must be able to interact cordially and productively with a variety of people.

2. Must be able to work independently and manage deadlines.

3. Must be able to market Goodwill and explain the mission to the general public.

4. Ability to use general office equipment including computer and be proficient in basic software applications (Microsoft Word, Outlook, Excel, Publisher).

5. Must possess excellent organizational, time management, and communication skills.

6. Must be able to take initiative, make sound decisions and work well with little supervision.

7. Must be able to keep information confidential.

8. Must be able to read, write and communicate clearly in English with payers and internal staff.

9. Must be able to maintain an effective working relationship with, and among employees while motivating them to their best performance.

10. Ability to function in a hectic work environment with occasional periods of high stress.

11. Must be able to travel frequently through the Gulf Coast area including some overnight stays.

12. Must obtain and retain First Aid/CPR/AED certification and respond to and manage a first aid, choking or sudden cardiac arrest emergency at the worksite according to Goodwill Safety Policies & Procedures.

13. Must have reliable means of transportation, must have a valid driver’s license for at least 3 years, liability automobile insurance and be insurable through the agency’s insurance carrier.

14. Must be at least 21 years of age.

Experience and Education Requirements:

· Minimum 2 year’s experience in medical billing with direct experience in Medicaid and private insurance billing.

· Strong understanding of CPT/HCPCS codes, modifiers, and billing requirements for assessments, therapy or behavioral health services.

· Experience using payer portals, clearinghouses, and EHR systems.

· Experience and knowledge with provider enrollment and credentialing workflows.

· Knowledge of insurance eligibility, authorization workflows, and denial management.

· Strong organizational skills and attention to detail.

· Strong interpersonal skills with the ability to communicate complex information to patients, families, and colleagues.

Physical Requirements:

· Must be able to use hands, fingers and wrists, repetitively while using computer keyboard.

· Must be able to sit for prolonged periods of time.

· Must be able to stand, bend, sit on the floor, stoop, walk, talk, hear, use hands to grip, and reach with arms, and carry items weighing up to 20 lbs.

Working Conditions: Adequately lighted and ventilated building. Frequent travel throughout the Gulf Coast area.

Critical Performance Factors:

1. Meeting or surpassing performance measures for funded program.

2. Positive relationships with funders, stakeholders, customers and community partners

3. Quality of services provided

4. Adherence to program standards and requirements

5. Management and accountability of resources

Salary : $16 - $18