Medical Billing Specialist

Summary

Epworth seeks an experienced Medical Billing Specialist to lead disciplined revenue cycle execution and bring billing functions in-house. This role will be responsible for accurate and timely claims submission, state and local government program invoicing, denial management, payment posting, billing process control, and continuous improvement in reimbursement performance, with particular emphasis on Medicaid, managed care, and state and local government-funded program billing.

This is a hands-on role for an experienced professional who combines strong technical billing knowledge with rigorous process discipline and a focus on strengthening reimbursement performance and cash realization.

 

Primary Responsibilities

• Manage day-to-day billing and revenue cycle execution for Medicaid, managed care organizations, third-party payers, and state and local government-funded reimbursement programs related to foster care, behavioral health, and residential treatment services
• Prepare, review, and submit accurate claims, ensuring coding, documentation, and billing integrity to support clean claim submission and minimize denials
• Manage billing, reimbursement, and contract invoicing related to Missouri Medicaid and state and local government-funded programs, including Show Me Healthy Kids and applicable St. Louis City and County funding sources, ensuring accurate invoicing, documentation support, and compliance with program requirements
• Investigate and resolve claim rejections, denials, and billing exceptions in a timely and disciplined manner
• Post payments, remittances, and adjustments accurately within billing and accounting systems
• Maintain disciplined billing work queues to support timely claims submission, exception resolution, and process control
• Bring billing functions in-house and manage those functions internally
• Identify denial patterns, process gaps, claims leakage, and reimbursement issues, and recommend improvements to strengthen billing accuracy, timeliness, and cash realization
• Support billing-related reconciliations and coordinate with finance to support internal controls and month-end close processes
• Collaborate with program leads, case managers, clinical staff, and administrative teams to ensure documentation supports compliant reimbursement
• Ensure compliance with federal, state, local, payer, and nonprofit funding requirements, including support for audits and documentation requests
• Work effectively with payer portals, billing systems, clearinghouses, and preferably Sage Intacct to support accurate billing operations and reporting

• Other job duties as assigned.

Supervisor Responsibilities: None

Qualifications:

• 5–7+ years of progressive revenue cycle, medical billing, reimbursement operations, or government-funded program billing experience
• An Associate of Applied Science, or Medicaid billing certificate – preferred, but not required.
• Significant experience with Medicaid billing required; managed care experience strongly preferred
• Experience with Medicaid reimbursement and state or local government-funded program billing, including contract invoicing, strongly preferred
• Experience in behavioral health, foster care, nonprofit healthcare, or related human services environments strongly preferred
• Demonstrated experience improving billing operations, resolving denials, and strengthening revenue cycle discipline
• Experience bringing billing functions in-house or improving fragmented billing processes preferred
• Experience with electronic health records, payer portals, clearinghouses, and billing systems required
• Familiarity with Sage Intacct or similar financial systems a plus