Billing and Authorization Specialist | NJ Medicaid | Remote (Must Live in NJ)

Full-Time | Starting at $60,000 per Year | Home Care Experience Required

About the Opportunity

We are seeking an experienced Billing and Authorization Specialist to support New Jersey Medicaid-funded home care services.

This fully remote opportunity is ideal for a detail-oriented healthcare professional with hands-on experience in Medicaid billing, client eligibility verification, service authorizations, and managed care payer portals.

The position focuses on ensuring accurate claims processing, maintaining service authorizations, resolving billing discrepancies, and supporting timely reimbursement.

Previous home care experience and New Jersey Medicaid knowledge are required.

Compensation

• Starting salary of $60,000 per year

• Higher compensation available based on experience and qualifications

• Full-time, fully remote position

Key Responsibilities

• Manage billing and claims processing for New Jersey Medicaid-funded home care services.

• Submit, review, and monitor claims through Medicaid and managed care organization (MCO) payer portals.

• Verify client Medicaid eligibility, coverage, and managed care enrollment.

• Obtain, review, track, and renew authorizations for home care services.

• Confirm approved service hours, units, service codes, effective dates, and expiration dates.

• Identify and resolve billing discrepancies, rejected claims, denials, and reimbursement issues.

• Prepare corrected claims and supporting documentation for resubmissions or appeals.

• Review service documentation to ensure consistency with approved authorizations.

• Monitor authorization renewals and proactively address potential service interruptions.

• Reconcile payments, review remittance information, and investigate reimbursement discrepancies.

• Communicate with Medicaid payer representatives, care coordinators, and internal operations teams.

• Maintain accurate billing records, authorization tracking systems, and supporting documentation.

• Monitor timely filing deadlines, outstanding claims, and authorization requests.

• Ensure compliance with Medicaid requirements, payer guidelines, and organizational procedures.

Required Qualifications

• Previous billing or authorization experience within a home care or home health organization.

• Working knowledge of New Jersey Medicaid billing, eligibility, and service authorization processes.

• Experience navigating Medicaid managed care payer portals.

• Familiarity with claims submission, claim status tracking, denial resolution, and reimbursement follow-up.

• Ability to review and interpret service authorizations, approved hours, units, and coverage dates.

• Strong organizational skills and attention to detail.

• Ability to independently research and resolve billing and authorization discrepancies.

• Excellent written and verbal communication skills.

• Proficiency with electronic healthcare records, billing software, and Microsoft Excel.

• Ability to work independently and manage multiple priorities in a remote environment.

Preferred Qualifications

• Experience working with New Jersey Medicaid managed care organizations, including Horizon NJ Health, Aetna Better Health, UnitedHealthcare Community Plan, and Wellpoint.

• Familiarity with Medicaid Managed Long Term Services and Supports (MLTSS).

• Experience supporting personal care assistance (PCA), home health aide, or other Medicaid-funded home care services.

• Experience resolving claims affected by authorization limits, eligibility discrepancies, or service documentation issues.

• Familiarity with electronic visit verification (EVV) and its relationship to authorized services and billing.

• Experience coordinating with case managers, care coordinators, and payer authorization departments.

Remote Work and Location Preference

This is a fully remote position.

• First preference given to qualified New Jersey residents.

• Candidates residing elsewhere in the Eastern Time Zone may also be considered.

• Full-time availability required.

• Must