Billing Specialist

Essential Duties and Responsibilities

Billing and Claims Management

• Prepare, review and submit Medicaid waiver claims accurately and on time
• Process billing for New Jersey DDD and Pennsylvania ODP services
• Review service documentation to ensure all billing requirements have been met prior to claim submission
• Verify authorizations and billing eligibility before claims are submitted
• Ensure compliance with Medicaid regulations, payer requirements and agency policies
• Monitor claim edits and resolve billing exceptions before submission

Accounts Receivable Management

• Monitor outstanding claims and accounts receivable
• Investigate denied, rejected unpaid or partially paid claims
• Prepare appeals and supporting documentation when appropriate
• Maintain accurate documentation of billing activities and follow up efforts

Payment Posting and Reconciliation

• Post electronic remittance advice (ERA) and manual payments
• Reconcile payments against submitted claims
• Identify underpayments, overpayments and payment variances
• Assist with monthly reconciliation and revenue reporting
• Work collaboratively with Finance to ensure billing accuracy

Documentation and Compliance

• Ensure billing documentation supports all submitted claims
• Maintain compliance with Medicaid, HIPAA and state regulations
• Stay informed of changes to New Jersey DDD and Pennsylvania ODP billing requirements
• Assist with internal and external audits

Collaboration

• Work closely with Clinical, Program Operations, Scheduling, Payroll, Human Resources and Finance departments
• Communicate with state agencies, managed care organizations and payers regarding billing issues
• Participate in process improvement initiatives to improve billing accuracy and efficiency
• Provide excellent customer service to internal departments regarding billing inquiries 

Heart to Heart is seeking a highly organized, detail-oriented and experienced Billing Specialist to join our Revenue Cycle Management team.  This position is responsible for the timely, accurate and compliant billing of Medicaid waiver services for individuals receiving Intellectual and Developmental Disabilities (IDD) services in New Jersey (Division of Developmental Disabilities - DDD) and Pennsylvania (Office on Developmental Programs - ODP).

The ideal candidate will possess strong knowledge of Medicaid billing regulations, revenue cycle processes and electronic billing systems.  Experience with Therap, PROMISe and HCSIS is highly preferred.  The successful candidate will be responsible for ensuring clean claims, minimizing denials, maximizing reimbursement and supporting the financial health of the organization.

Why Join Heart to Heart?

At Heart to Heart, our mission is to improve lives by providing exceptional services to individuals with intellectual and developmental disabilities.  Our Billing Specialists play a vital role in ensuring the financial integrity of our organization, allowing our clinical and program teams to focus on delivering high-quality care.  We value collaboration, accountability, innovation and continuous improvement and we are committed to supporting the professional growth of every team member.

Heart to Heart is proud to be an Equal Opportunity Employer.  We celebrate diversity and are committed to creating an inclusive workplace where every employee is respected and empowered to succeed.

Required Qualifications

• High School Diploma or Equivalent required; Associates or Bachelors degree preferred
• Minimum of two (2) years of medical billing, Medicaid billing or revenue cycle management experience
• Strong understanding of claims processing, payment posting, accounts receivable and denial managment
• Excellent organizational and analytical skills
• Strong written and verbal communication abilities
• High level of attention to detail and accuracy
• Ability to prioritize multiple deadlines in a fast paced environment
• Proficiency in Microsoft Office, particularly Excel

Preferred Qualifications

• Experience billing New Jersey Division of Developmental Disabilities (DDD) services
• Experience billing Pennsylvania Office of Developmental Programs (ODP) services
• Experience using Therap for service documentation, billing validation and provider workflows
• Experience using PROMISe for Pennsylvania Medicaid billing, claim inquiry, payment reconciliation and remittance review
• Experience navigating HCSIS (Home and Community Services Information System) to review authorizations, service plans, provider information and waiver services
• Knowledge of Electronic Visit Verification (EVV) requirements
• Experience billing residential, community-based, day habilitation, behavioral support, employment, respite and other waiver-funded IDD services
• Familiarity with Medicaid managed care and fee-for-service billing
• Experience with electronic remittance advice (ERA), appeals, denial resolution and payment reconciliation

Technical Skills

Preferred Experience with:

Therap
PROMISe
HCSIS
Electric Visit Verification (EVV) platforms
Medicaid Billing Software
Electronic Health Records
Clearinghouse claim submission portals
Microsoft Excel (including filtering, pivot tables and reconciliation functions)

Core Values

Joyful Excellence
Heartfelt Devotion
Authentic Commitment

Performance Expectations (Key Performance Indicators)

The Billing Specialist will be evaluated on:

• Timely claim submission
• Clean claim rate
• Denial rate
• Days in Accounts Receivable (A/R)
• Billing accuracy
• Timeliness of payment posting
• Resolution of denied and rejected claims
• Compliance with documentation standards
• Responsiveness to internal department
• Contribution to revenue cycle improvements

Physical Requirements

• Ability to remain seated for extended periods while working at a computer
• Ability to communicate effectively via phone, video conferencing and email
• Ability to occasionally lift up to 15 pounds
• Ability to work on site at the East Orange headquarters

Work Environment

This position is office based and occasional overtime may be required during billing processing or other critical billing periods.