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About The Position
The Medicaid Claims Analyst supports GOBHI’s Non-Emergent Medical Transportation (NEMT) program by reviewing, processing, and reconciling Medicaid claims to ensure accuracy, compliance, and timely reimbursement. This position is responsible for coding, billing, auditing, and reconciliation functions related to NEMT services, serving as a key liaison between transportation providers, internal staff, and state Medicaid offices. This role ensures that all claims activities comply with federal and state regulations while supporting program efficiency, accuracy, and integrity.
Requirements
- Two years’ experience in Medicaid claims processing, billing, or healthcare reimbursement.
- Knowledge of Medicaid billing, HCPCS/CPT coding, and claims submission requirements.
- Strong analytical skills and attention to detail.
- Excellent problem-solving, communication, and organizational abilities.
- Handles highly sensitive and confidential information and complies with HIPAA requirements.
- Technology savvy, proficient using MS software and Google Suites.
- Experience with claims management systems, billing software, and Microsoft Excel.
- Capacity to handle multiple priorities and meet strict deadlines.
- Associate’s degree in Business, Accounting, Healthcare Administration, or a related field.
Nice To Haves
- Experience working in transportation claims strongly preferred.
- Bachelor’s degree preferred.
Responsibilities
- Review, validate, and process NEMT claims in accordance with Medicaid policies, GOBHI program guidelines, and contractual requirements.
- Perform accurate billing and coding for NEMT claims using appropriate HCPCS/CPT codes.
- Verify member eligibility, trip authorization, and service documentation prior to submission.
- Ensure claims are submitted within required timelines and track adjudication through final payment.
- Identify and resolve claim errors, discrepancies, and denials in coordination with providers and program staff.
- Maintain current knowledge of Medicaid billing codes, guidelines, and NEMT-specific requirements.
- Conduct regular audits of NEMT claims to detect and prevent errors, overpayments, or potential fraud.
- Support corrective action plans and recommend process improvements to strengthen billing integrity.
- Accurately code trips and services in compliance with Medicaid and NEMT guidelines.
- Prepare, review and submit billing batches to Medicaid and other payers.
- Reconcile claims against payments, identifying variances or unpaid balances.
- Collaborate with GOBHI finance staff to support accurate accounting and reporting.
- Generate and maintain reports on claims activity, denial rates, and reimbursement trends.
- Provide data analysis to identify cost drivers, claim patterns, and areas for improvement.
- Serve as a resource for NEMT providers regarding Medicaid billing procedures, documentation, and claim resolution.
- Upon supervisor’s approval and direction, update and maintain provider rate contracts.
- Provide training and technical assistance to providers on coding, billing, and submission processes.
- Other duties as assigned.
Benefits
- Medical, dental and vision insurance for you and dependents
- 22 paid time off days and 12 paid holidays
- EAP
- FSA, with a $500 employer contribution
- Triple AAA insurance
- Mileage reimbursement
- Wellness benefits
- 401k contribution, including 6.5% employer contributions
- Cell phone and internet reimbursements
