Sr. Billing Specialist
$30–$33 year
On-siteRochester, New York, United States
Job Summary
Prepare and submit timely clean claims electronically or by paper while reviewing census and payer data for accuracy before submission. Monitor claim status to proactively resolve billing edits, rejections, denials, and underpayments, then manage appeals and reconsiderations for disputed claims. Utilize accounts receivable aging reports to identify outstanding balances, follow up with insurance carriers regarding unpaid claims, and investigate payment variances to coordinate corrective actions. Collaborate with admissions, clinical, and finance teams to ensure accurate reimbursement and assist in month-end accounts receivable reconciliation. Maintain current knowledge of CMS regulations and payer guidelines while identifying opportunities to improve billing processes and strengthen cash collections. Serve as a resource to team members regarding Medicare and Managed Care billing requirements and participate in audits and regulatory reviews as assigned.
Required Qualifications
- High school diploma or equivalent
- Associate degree
- Minimum five (5) years of healthcare billing experience
- Minimum three (3) years of Skilled Nursing Facility (SNF) or long-term care (LTC) billing experience
- Demonstrated expertise in Medicare Part A, Medicare Advantage, Managed Care and third-party payer billing
- Experience with denial management, appeals, collections, and accounts receivable follow-up
- Experience working directly with residents, families, and responsible parties regarding insurance benefits, financial obligations, and billing inquiries
- Knowledge of coinsurance, copayment, deductible, and secondary insurance coordination
- Ability to explain complex reimbursement and insurance information in a clear and compassionate manner
- Strong analytical, organizational, and problem-solving skills
- Proficiency in Microsoft Excel, Word, Outlook, and billing systems
- Ability to work independently, prioritize multiple responsibilities and meet deadlines
- Committed to embracing and exemplifying St. John's mission, vision, values and Brand Characteristics
- Advanced knowledge of SNF reimbursement methodologies and regulatory requirements
- Expertise in Medicare Part A and Medicare Advantage billing processes
- Ability to identify reimbursement opportunities and resolve complex billing issues
- Strong understanding of payer contracts, authorizations, claims edits and reimbursement rules
- Ability to analyze aging reports and develop action plans to accelerate collections
- Experience managing claim denials, appeals, audits and payer correspondence
- Ability to educate and support team members regarding billing requirements and process improvements
- Strong attention to detail while maintaining productivity and accuracy
- Ability to communicate plan coverage to residents and resident families
- Requires frequent sitting, standing, twisting, stooping, handling, bending and walking associated with a normal office environment
- Manual dexterity needed for using a calculator and computer keyboard
- Visual acuity required to review billing records, insurance documentation and computer screens
- Ability to communicate effectively with residents, families, staff and third party payers
Desired Qualifications
- PointClickCare
- Excellent verbal and written communication skills
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