Billing Specialist

3M’s Services LLC

The Medicaid Billing Specialist is a vital part of the Finance and Compliance infrastructure at 3M’s Services LLC. This role ensures the accurate, timely, and compliant processing of Medicaid and MCO claims for services delivered under the NC 1915(i) and 1915(c) waiver programs, including Residential Supports, Community Living & Supports, Day Supports, Community Networking, Respite, and other habilitative services.

As a Medicaid Billing Specialist, you will be responsible for reviewing service documentation, verifying authorizations, reconciling units, and processing weekly billing across multiple MCOs such as Alliance Health, Partners BHM, Vaya, Sandhills, Eastpointe, and others. This position plays a key role in ensuring providers are paid accurately and promptly while maintaining strict adherence to NC DHHS billing guidelines, MCO policies, HIPAA requirements, and internal quality standards.

Key functions of this role include:

• Reviewing daily and weekly service notes to ensure they meet Medicaid documentation standards (timeliness, content accuracy, staff credentials, and correct service codes).
• Verifying active authorizations and reconciling units to prevent over-utilization or under-billing.
• Identifying and correcting billing errors such as overlapping services, duplicate claims, unauthorized services, expired service orders, or mismatched CPT/HCPCS modifiers.
• Preparing and submitting weekly billing batches for all service lines by established deadlines.
• Analyzing MCO Remittance Advice (RA) reports to identify denials, reductions, reversals, or recoupments and developing corrective action plans with QPs and Supervisors.
• Communicating with MCO representatives, internal departments, and leadership to resolve billing discrepancies and ensure compliance.
• Assisting with audits by maintaining organized billing records, documentation, and supporting evidence for claims.
• Supporting rate updates, new codes, and policy changes to ensure 3M’s Services maintains compliance with ongoing Medicaid and MCO regulatory updates.
• Tracking back-pay opportunities and ensuring all eligible claims are submitted correctly within timely-filing limits.

This role requires strong analytical skills, excellent communication, and the ability to work independently in a fast-paced environment. The ideal candidate is organized, detail-oriented, and capable of managing multiple priorities while maintaining exceptional accuracy. A foundational understanding of Medicaid billing, authorization structures, and IDD services is strongly preferred.

At 3M’s Services LLC, you will contribute directly to ensuring the financial stability of the organization and supporting our mission to provide consistent, high-quality services to individuals with intellectual and developmental disabilities and mental health needs.