Sr. Billing Specialist

Essential Duties and Responsibilities

Billing & 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

• Submit corrected claims and rebill services as necessary.

Accounts Receivable Management

• Monitor outstanding claims and accounts receivable.

• Investigate denied, rejected, unpaid, or partially paid claims.

• Research billing discrepancies and coordinate timely resolutions.

• Prepare appeals and supporting documentation when appropriate.

• Maintain accurate documentation of billing activities and follow-up efforts.

Payment Posting & 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 & 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 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 of 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.

Required Qualifications

• High School Diploma or equivalent required; Associate's 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 management
• 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 is 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

Technical Skills

• Therap
• PROMISe
• HCSIS
• Electronic Visit Verification (EVV) platforms
• Medicaid billing software
• Electronic Health Record (EHR) systems
• Clearinghouse claim submission portals
• Microsoft Excel (including filtering, pivot tables and reconciliation functions)