● Salary range: $55,000–$65,000.

● Employment Type: Full-Time, Exempt.

● Hours: 40 hours/week with a flexible schedule.

● Work Location: Remote, hybrid, or in-person.

● Benefits: Medical, dental, & vision insurance; paid time off; paid holidays.

● Priority application deadline: 11:59 pm on Thursday, March 19th.

To apply: Combine your cover letter and resume into one PDF and email to hiring@flourishtherapy.org with the subject: “Medicaid Specialist Application for [your full name]”.

Position Summary

The Medicaid Insurance Specialist is responsible for managing all aspects of Medicaid-based insurance processes for Flourish Therapy as well as general billing team support. This role ensures accurate authorizations, claims submission, payment posting, and issue resolution to support clinic sustainability and uninterrupted client care. The ideal candidate is detail-oriented, proactive, and skilled in Medicaid billing regulations and managed care processes.

Key Responsibilities

Authorizations & Eligibility

● Verify Medicaid/insurance eligibility and managed care enrollment for clients.

● Obtain, track, and renew service authorizations (initial primary focus is Optum and Healthy U)

● Monitor authorization limits and notify clinical staff of upcoming expirations.

Claims & Billing

● Prepare, submit, and track claims through clearinghouses or payer portals

(primary focus = Medicaid claims).

● Ensure claims meet all state, federal, and payer-specific requirements.

● Correct and resubmit denied or rejected claims in a timely manner.

● Maintain accurate documentation in the electronic health record (EHR) and billing systems.

Payment Posting & Reconciliation

● Post insurance payments and adjustments accurately.

● Reconcile remittance advice (ERAs/EOBs) and identify underpayments or errors.

● Track outstanding balances and follow up on unpaid claims.

Denials & Appeals

● Investigate claim denials and payer discrepancies.

● Prepare and submit appeals with supporting documentation.

● Communicate with payer representatives to resolve billing issues.

Compliance & Quality Assurance

● Maintain compliance with Medicaid regulations, state guidelines, and payer policies.

● Stay current on changes to Optum and Healthy U billing rules and procedures.

● Participate in audits and internal quality assurance processes.

Collaboration & Support

● Work closely with clinicians, intake staff, billing team, and leadership to support smooth client access to services.

● Provide guidance to staff regarding Medicaid, insurance requirements, and documentation standards.

● Assist with training and process improvements related to billing, reimbursement, and Medicaid.

Desired Qualifications

Below, we describe key qualifications for candidates while remaining open to diverse experiences that develop the desired skill sets. Studies have shown that marginalized communities, such as women, LGBTQ+, and people of color, are less likely to apply for jobs unless they meet every single qualification. We encourage anyone who feels passionate about this work to apply.

● 3+ years of experience in Medicaid billing or insurance revenue cycle management. Direct experience with Optum and Healthy U strongly preferred.

● Knowledge of Medicaid regulations, managed care requirements, and behavioral health billing.

● Familiarity with Utah Medicaid policies and behavioral health coding (CPT/HCPCS, modifiers).

● Experience with claim appeals and payer audits.

● Proficiency with Electronic Health Record (EHR) and billing systems.

● Strong attention to detail, organization, and problem-solving skills.

● Ability to work independently while collaborating with a multidisciplinary team.

● Excellent communication and customer service skills.

● Experience in a nonprofit or community mental health setting.