The Medicare/Medicaid Billing Specialist plays a pivotal role in our organization by overseeing the review, scrubbing, submission, recording, and collection processes for all insurance billing and payments related to Medicare and Medicaid. This position offers the flexibility of working fully remote or through a hybrid arrangement.
Requirements
Bachelor's degree in business administration, accounting, finance, or a related field OR equivalent work experience.
3 to 5 years of experience in Medicare/Medicaid billing within a Skilled Nursing or Long-Term Care environment.
Proficiency in working with third-party insurance companies and tracking/posting cash.
Familiarity with UB forms and strong knowledge of ICD-10 & CPT coding, PDPM, PT, OT, and ST coding, condition codes, occurrence span codes and dates, and billing guidelines.
Understanding of CMS/Medicare billing regulations and third-party payer types.
Strong Microsoft Office skills; willingness to adapt to new technologies.
Responsibilities
Monthly billing of Medicare A and B claims, PDPM, and Medicaid for Skilled Nursing residents.
Submission of monthly bills to third-party insurance companies and preparation of secondary insurance submissions as necessary.
Reviewing and preparing UB claims for accurate electronic submission.
Ensuring timely and accurate submission of clean claims across all payer sources.
Reconciling patient care days between billing files and clinical reports.
Daily management of Medicare Suspense files and proactive pursuit of past-due claims.
Collaborating with Medicare/Medicaid, clinical, and business office teams to facilitate timely payments.
Managing denial management and collections procedures to secure payments.
Handling HIPPS coding changes due to audits or clinical updates post-claim processing.
Monitoring daily reports for errors and conducting necessary corrections.
Reviewing posted payments and adjustments, investigating and resolving payment discrepancies.
Documenting all activities and status updates in billing software.
Regularly communicating status updates with the business office and management.
About Us
We are a leader in providing compassionate care and support across multiple communities in New Jersey. Certified as a Great Place to Work for six consecutive years, we are committed to growth and innovation while upholding over 115 years of service excellence. Our company culture is founded on values of Compassion, Respect, Stewardship, and Service.
Benefits
Employer-subsidized Medical and Dental Coverage (eligible at 30 hours per week)
403(b) Retirement Savings Program with Employer Match
Employee Assistance Program, Tuition Assistance, Professional Development, and E-Learning opportunities
Generous Paid Time Off Program, Group Life Insurance, 9 Paid Holidays, Premium Pay for holiday work
Free uniform items and additional allowances, Vision coverage, Health Savings Account, Voluntary Life Insurance, and more!
Equal Opportunity Employer
We are an equal opportunity employer and value diversity in our workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, disability status, or any other characteristic protected by applicable laws and regulations.
Employment Type: Full-Time
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Accounting/Auditing and Finance
Industries
Human Resources Services
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