EDI EDI BILLING AND MEDICAID CLAIMS SPECIALIS

EDI BILLING AND MEDICAID CLAIMS SPECIALIST

Palco is a visionary company pioneering an emerging health-care movement that empowers people with disabilities and those aging to live independent and quality lives. Made possible by our amazing team, Palco provides technology and financial services to aid individuals and their families to thrive in their home and communities. Partnered with government agencies and fortune 500 managed care organizations across the country, we are dedicated to creating exceptional outcomes for our clients and the millions of people that count on them. We are a highly organized company that offers a solid work/life balance, autonomy, generous paid time off, bonus potential, and career advancement opportunities. Our staff make long-lasting impact on the lives of people every day.

Job Summary:
We are seeking a detail-oriented and self-motivated EDI Billing & Medicaid Claims Specialist to support our revenue cycle operations. This role requires expertise in 837 EDI file processing, Medicaid billing portals, and EMR systems to ensure accurate and timely claim submissions. The ideal candidate will have strong problem-solving and critical-thinking skills, the ability to analyze denial codes, and the initiative to resubmit and reconcile claims efficiently.

This is a remote position requiring independent work with minimal supervision. The candidate must be highly organized, meet claim resolution timelines and denial reduction targets, and demonstrate strong Excel skills for data analysis and reporting.

Key Responsibilities:

• Submit, process, and troubleshoot EDI claims (837, 277, 276, 835, 270, 271 transactions) for Medicaid and Managed Care Organizations.
• Conduct eligibility checks and ensure provider enrollment with Medicaid, MMIS, and Managed Care Organizations.
• Understand procedure billing and diagnosis codes, identify denial reasons, and take corrective action.
• Resubmit failed claims and proactively follow up to ensure resolution.
• Manage the reconciliation and rebilling process to maintain revenue cycle efficiency.
• Prepare regular billing reports for management review, compiling, analyzing, and evaluating billing data.
• Ensure compliance with HIPAA, state, and federal tax and regulatory authorities.
• Provide support for ad-hoc projects initiated by management.
• Work closely with clients, partners, and internal teams to resolve FMS-related billing issues.
• Develop strong working relationships with providers and Medicaid payers.
• Provide exceptional customer service and maintain professionalism in all interactions.

Required Qualifications:

• Minimum 3 years of experience in Medicaid billing, EDI processing, and revenue cycle management.
• Proficiency in 837 claim submission and reconciliation processes.
• Strong knowledge of Medicaid portals, MMIS, and Managed Care Organization billing requirements.
• Understanding of denial codes, rebilling, and revenue cycle workflows.
• Advanced Excel skills, including VLOOKUPs, pivot tables, and conditional formulas (e.g., SUMIF, COUNTIF).
• Ability to analyze complex data, think critically, and solve problems independently.
• Self-starter with excellent organizational and time-management skills.
• Strong attention to detail and ability to meet claim resolution timelines.
• Experience working remotely with minimal supervision.

Preferred Qualifications:

• Degree or certification in healthcare administration, accounting, or a related field.
• Experience with multiple Medicaid billing platforms and EMR systems.

This position offers the flexibility of remote work while requiring a proactive and results-driven approach. If you have the skills to navigate the complexities of Medicaid billing and EDI claims, we encourage you to apply!

Join Us

This position is remote/work-from-home role. Enjoy the convenience of working from home and maximize your time by unplugging at the end of your workday.

Company benefits designed for you:

• • Generous Paid time off.
  • Quarterly/Annual bonus potential.
  • Retirement Savings: We will support you as you save for your future.
  • Career Growth Opportunities: We help you thrive, so together, we can grow. We provide opportunities to advance your career with a vast portfolio of businesses and a global footprint.
  • Paid Training: Earn while you learn, and continue to grow with access to internal and external learning opportunities.
  • Great Work Environment: We are proud of our company culture of collaboration and the recognition we’ve received for our diversity efforts.

When you join Palco, you are engaged in creating the future - both our company’s, the people we serve, and your own. We understand that our success is directly related to the success of our team. We strive to create a culture where you can:

• • Bring your authentic self to work.
  • Grow and thrive, both personally and professionally.
  • Make a difference with our clients, in our communities, and with the millions of people we support.
  • Experience work/life balance.
  • Feel value and a greater purpose through the work you do.

Palco, Inc. is an Equal Employment Opportunity (EEO) employer and does not discriminate in any employer/employee relations based on race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law.