Billing Specialist

SUMMARY:

The Billing Specialist is responsible for verifying insurance coverage, accurately setting up patient accounts, and processing census changes within the billing system. This role ensures efficient billing and collection processes to support timely reimbursement for all billable services, including Medicare, Medicaid, commercial insurance, and other third-party payors. The ideal candidate is detail-oriented and experienced in medical billing, with strong knowledge of insurance processes, reimbursement procedures, and healthcare compliance standards. This position plays a key role in maintaining billing accuracy and supporting the organization’s overall financial performance.

ESSENTIAL FUNCTIONS:

• Verification of insurance per Warm Hearth Policy and Procedure and initial set-up in billing system.
• Ensure accurate and timely billing of resident services, including private pay, Medicare, Medicaid, and other insurance plans.
• Maintain accurate financial records, including accounts receivable.
• Manage resident trust accounts in accordance with federal and state regulations.
• Monitor and maintain compliance with state, federal, and corporate guidelines for financial and administrative processes.
• Manually process claims as necessary
• Research claim denials, and determine specific steps to get claims paid
• Track and manage claim submissions, denials, rejections, and appeals.
• Maintain compliance with federal and state regulations, including HIPAA.
• Stay current with changes in billing codes, payer policies, and industry regulations.

Minimum Qualifications

• Education: Associate's degree, vocational technical degree or specialized training that is equivalent to satisfactory completion of 2 years of college in a related field or related work experience in healthcare billing.
• Experience: Minimum 2 years' experience in healthcare billing and insurance verification
• Proficiency in Microsoft Word, Excel, Power Point and Adobe.
• Excellent oral and written communication skills as well as strong interpersonal skills to communicate with all individuals including patients, residents and coworkers.
• Ability to work independently with minimal supervision as well as in a team environment.
• Strong knowledge of billing procedures, Medicare/Medicaid regulations, and insurance processes.
• Matrixcare, Brightree, or Wellsky billing system experience preferred.