Revenue Cycle Specialist

About This Role

The Revenue Cycle Specialist is responsible for the accurate and timely preparation, submission, and tracking of Delaware Medicaid claims and Food is Medicine programs. This role requires dedicated expertise utilizing Delaware Medical Assistance Portal (DMAP), Delaware’s Medicaid Enterprise System (DMES), and Therap. You will work closely with program staff, service coordinators, and finance personnel to resolve billing issues and maximize appropriate reimbursement while maintaining compliance with applicable Medicaid and Division of Developmental Disabilities Services (DDDS) requirements.

Responsibilities

• Prepare, code, and electronically transmit Medicaid claims directly through DMAP, ensuring all fields align with Delaware state specifications
• Coordinate and process claim and billing submissions for Food Bank of Delaware programs including Food is Medicine, using prescribed methods under each contract/MOU
• Review weekly and and monthly Medicaid Remittance Advices (RAs) via DMAP and other payment methods for Food is Medicine
• Post payments and accurately adjust accounts according to allowed amounts
• Conduct research on rejected, denied, or underpaid claims using DMAP’s claim status tools
• Correct coding errors, attach necessary medical necessity documentation, and resubmit claims within the state’s timely filing limits
• Conduct research on other related claim discrepancies and file corrections for the Food Bank of Delaware’s Food is Medicine Programs
• Validate patient Medicaid eligibility, managed care organization (MCO) enrollment, and benefit limits through DMAP prior to service delivery
• Keep up to date on changes to Delaware Medicaid provider manuals, fee schedules, and billing policy updates
• Ensure all billing activities strictly adhere to HIPAA regulations, Joint Commission standards, and other regulatory standards
• Generate monthly billing, adjustment, and revenue recovery reports for management to track Medicaid reimbursement metrics
• Perform other duties as assigned

Requirements

• 2+ years of dedicated medical billing experience, with a strict focus on Delaware Medicaid and DMAP systems
• Experience with DDDS-funded services or services for individuals with intellectual/developmental disabilities preferred
• Exceptional attention to detail and accuracy, and clear professional communication skills
• Ability to interpret billing records, service documentation, authorizations, and payer information
• Strong organizational and time-management skills
• Ability to research and resolve billing discrepancies independently
• Proficiency with Microsoft Office, particularly Excel
• Ability to maintain confidential information and exercise sound judgment