Sr. Billing Specialist

Position Summary: The Senior Billing Specialist - Skilled reports directly to the Director of Revenue Cycle Management and serves as a subject matter expert for Skilled Nursing Facility (SNF) reimbursement. This position is responsible for accurate and timely billing, collections, account reconciliation, denial management, and payment posting for Medicare Part A, Medicare Advantage, Managed Care, and other third-party payers. The Senior Billing Specialist collaborates closely with clinical, MDS, rehabilitation, admissions, and finance teams to maximize reimbursement, resolve billing issues, and ensure compliance with applicable regulations and payer requirements.

Qualifications & Education Required:

• High school diploma or equivalent required; Associate degree preferred
• Minimum five (5) years of healthcare billing experience required
• Minimum three (3) years of Skilled Nursing Facility (SNF) or long-term care (LTC) billing experience required.
• 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
• Proficient in Microsoft Excel, Word, Outlook, and billing systems. Proficiency in PointClickCare is desirable.
• Excellent verbal and written communication skills
• Ability to work independently, prioritize multiple responsibilities and meet deadlines.
• Committed to embracing and exemplifying St. John’s mission, vision, values and Brand Characteristics.

Core Organizational Competencies:

• St. John’s Brand Characteristics - Embrace living by being Friendly, Respectful, Responsive, Compassionate, Innovative and Fun towards elders, families and colleagues.
• Teamwork - Actively participates. Assists team members; offers encouragement. Acknowledges/welcomes elders. Keeps team members informed. Recognizes achievements and efforts of others. 
• Job Knowledge - Consistently demonstrates working knowledge of all aspects of job. Remains current on job related changes and trends.
• Planning/Organization - Demonstrates initiative; plans appropriately. Uses time, materials, resources effectively. Organizes work to ensure commitment and priorities.
• Productivity - Consistently maintains high activity and efficiently produces acceptable volume of work. Consistently meets deadlines and commitments.
• Quality - Consistently produces accurate, timely work which meets required quality standards. Pays attention to detail. Sets high standards of performance for self and actively seeks continuous improvement. Provides elder-driven care.
• Reliability - Consistently delivers on commitments. Can be counted on to accomplish tasks without follow up. Available when required by elder or team and can be counted on to help or assist when needed. Responds in a timely manner.
• Demeanor (attitude) - Embraces change with optimism. Addresses concerns appropriately. Positively communicates. Good listener. Consistently maintains a positive demeanor.

Position Competencies:

• 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

Position Responsibilities:

• Prepares and submits timely clean claims to various insurance companies either electronically or by paper
• Responsible for co-insurance and/or co-pay billing to residents and/or responsible parties
• Ensure claims are submitted timely and comply with payer-specific requirements
• Review census, payer, and reimbursement information for accuracy prior to claim submission
• Monitor claim status and proactively resolve billing edits, rejections, denials and underpayments
• Manage appeals and reconsiderations for denied or disputed claims
• Utilize accounts receivable aging reports to identify and resolve outstanding balances
• Follow up with insurance carriers and managed care organizations regarding unpaid claims and reimbursement issues
• Investigate payment variances and coordinate corrective actions
• Collaborate with Admissions, MDS, Rehabilitation, Clinical Operations, and Finance teams to ensure accurate reimbursement
• Maintain current knowledge of CMS regulations, Medicare Advantage requirements, payer guidelines and reimbursement changes
• Assist in month end accounts receivable reconciliation and reporting
• Identify opportunities to improve billing processes, reduce denials, and strengthen cash collections.
• Serve as a resource to other billing team members regarding Medicare and Managed Care billing requirements.
• Participate in audits, regulatory reviews, and special projects as assigned.
• Perform other duties as assigned in support of St. John's mission, vision, and values.

Physical Requirements:

• 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.

Exposure to Conditions:

• Normal office environment within a healthcare setting. Potential exposure to infectious diseases and other health-related conditions.