[Hiring] Medicaid MCO Claims Recovery & Reimbursement Contractor @Community Home Care Services LLC

Role Description

Community Enterprises is seeking a highly experienced Medicaid Billing & Denied Claims Recovery Contractor to help recover outstanding Medicaid Managed Care Organization (MCO) reimbursements owed to our business. We need a proven professional who can:

• Investigate, correct, rebill, appeal, and successfully recover payments on claims that have been rejected, denied, or otherwise remain unpaid.

CLAIMS RECOVERY PERIOD: JANUARY 1, 2026 – NOVEMBER 10, 2026

Qualifications

• Hands-on experience with Medicaid MCOs including:
• Absolute Total Care
• Healthy Blue / BlueCross BlueShield
• Select Health of South Carolina
• Molina Healthcare
• Other South Carolina Medicaid MCOs
• Experience with Availity Essentials Portal — MANDATORY
• Medicaid claims submission and resubmission
• Denied and rejected claims resolution
• Claims appeals and payment reconsiderations
• Medicaid DME and medical supply billing
• Incontinence supply claims and HCPCS coding
• Explanation of Benefits (EOB) and Electronic Remittance Advice (ERA)
• Provider enrollment, authorizations, and contract-related payment issues

Requirements

• Review outstanding Medicaid MCO claims dating back to January 1, 2026.
• Identify why claims were denied, rejected, or left unpaid.
• Correct billing errors and resubmit eligible claims.
• File appropriate appeals and reconsideration requests.
• Communicate directly with MCO claims departments and provider representatives.
• Research and resolve billing discrepancies, including authorization and contract issues.
• Track all outstanding balances and recovered payments.
• Provide management with weekly progress and recovery reports.
• Help establish procedures to prevent future claims denials and payment delays.

Benefits

• Flexible work from home options available.
• Multiple contract opportunities available.
• Potential for ongoing billing opportunities with additional projects.