Billing Specialist

Join The Highlands at Wyomissing as a Billing Specialist and play a vital role in supporting the financial health of our full continuum of care. This position oversees Medicare, Managed Care, and private pay billing across personal care, skilled nursing, and rehabilitation services, ensuring accurate reimbursement, regulatory compliance, and exceptional support to residents and families.

Summary of Responsibilities:

The Billing Specialist is responsible for managing the full scope of billing, claims processing, accounts receivable, and reimbursement activities within the personal care, nursing care, and rehabilitation environment of the organization. This role ensures timely and accurate billing to Medicare, Managed Care, and private payers while maintaining compliance with all regulatory requirements. Supports the operations of the Finance Department (i.e., performs financial analyses/projects; assists in the completion of all regulatory filings and monthly work paper(s); primary contact for all resident inquiries; supports insurance verification process).

Essential Functions/Duties:

Billing and Claims Management

• Prepare, review, and submit accurate claims to Medicare, Managed Care Organizations, private insurers, and third-party payers following regulatory and departmental standards.
• Submit all Medicare A, B, and Coinsurance claims and Managed Care claims promptly to receive reimbursements sooner, improving cash flow and the financial stability of the organization.
• Resubmit corrected or denied claims as needed and ensure all Additional Documentation Requests (ADRs) and Claims Audit requests are handled efficiently and promptly.
• Maintain up-to-date knowledge of healthcare billing regulations and policy changes affecting SNF billing.
• Coordinate and facilitate the Triple Check monthly audit to ensure accurate Medicare billing and optimal reimbursement. Maintain supporting documentation of the Triple Check audit.
• Receive, review, and enter first-party charges daily, weekly, and monthly.
• Prepare and distribute first-party billings following departmental targets and guidelines.

Accounts Receivable and Payment Processing

• Post all payments received from Medicare, Managed Care, and private pay sources in a timely and accurate manner, including appropriate allocation of co-pays and adjustments.
• Reconcile daily census data and monitor incoming reimbursement remittances.
• Investigate outstanding balances and take corrective action to resolve billing and payment discrepancies.
• Enter monthly ancillaries and journal entries related to resident charges and the Health Fund.
• Review aging reports weekly and follow up on unpaid claims or balances.

Resident and Insurance Account Management

• Maintain accurate resident billing records, including charges, payments, denials, adjustments, and insurance information.
• Verify insurance for all new admissions and update resident insurance databases regularly.
• Serve as the primary contact for residents and families regarding billing for nursing care, personal care, and insurance coverage.

Collections and Compliance

• Perform collection activities for both first party (residents) and third-party (insurance) accounts in alignment with departmental guidelines.
• Conduct internal audits and participate in Medicare Billing Compliance initiatives to ensure regulatory adherence.
• Document and justify all write-offs and adjustments according to department policy.
• Ensure billing and collection practices comply with Medicare, Medicaid, and other payer regulations.

Reporting and Month-End Close

• Actively participate in the month-end and AR close process, ensuring all data is accurate and complete.
• Assist in preparing financial reports, regulatory filings, and audit documentation.
• Support the Finance Department in problem resolution and special analytical projects.

Training and Special Projects

• Assist with the implementation of software updates, including reimbursement rate changes.
• Complete required ongoing training, certifications, and competency education to ensure continued competence and adherence to organizational and regulatory standards.
• Support other duties or projects assigned by management.

Required Skills/Abilities:

• Strong understanding of SNF billing procedures, ICD/CPT coding, and payer regulations (Medicare, Managed Care).
• Experience with billing and electronic health record software systems.
• Accuracy in claim preparation, payment posting, and account reconciliation.
• Excellent interpersonal skills for interacting with residents, families, and insurance payers.
• Ability to investigate and resolve billing and reimbursement issues effectively.
• Capable of handling multiple priorities and meeting tight deadlines.
• Ability to work under conditions that may be distracting and handle multiple interruptions of routine tasks.
• Ability to adapt to the organization's changing needs.
• Comfortable and agile working with technology; Proficient in MS Office and other applications.
• Excellent oral communication skills including a clear speaking voice.

Core Values:

• AMBASSADOR: Represents The Highlands at Wyomissing in a positive light with integrity. Takes pride in our community.
• COMMITMENT: Dedicated, adaptable, tolerant, dependable, focused, and passionate. Often does more than is required. Reports to work as scheduled and timely.
• COMPASSIONATE: Is empathetic, mindful, and kind.
• INNOVATIVE: Is curious. Identifies new methods and efficiencies.
• RESULTS-DRIVEN: Has a strong sense of urgency about solving problems and completing work. Exerts unusual effort over time to achieve a goal. Maintains commitment to goals in the face of obstacles and frustrations.
• TEAM ORIENTED: Works cooperatively and effectively with others to achieve common goals.

The Highlands' Traditions (Customer Service Expectations):

• SAFETY: Practices safe behaviors to ensure the safety of all.
• KINDNESS: Projects a positive image and energy. Courteous and respectful to all. Goes above and beyond to exceed customer expectations.
• SHOW: Takes pride in self-appearance. Stays in "character" and performs the "role in the show." Ensures work area is show-ready.
• EFFICIENCY: Performs role with consistency and efficiency. Uses time and resources wisely.

Position Type/Expected Hours of Work:

• This is a full-time position in a health care facility that is open 24 hours a day, 365 days a year. Days of work are Monday through Friday, and hours of work may vary depending on need. Work during inclement weather may be required.

Education and Experience Requirements:

• High school Diploma or GED (Required)
• Associate degree: Business or Accounting (Preferred)Minimum of 2-3 years' experience in healthcare billing, preferably in a long-term care, skilled nursing facility, or similar setting. (Required)
• Proven experience with Medicare, Managed Care, and third-party payer billing. (Required)
• Hands-on experience with electronic billing systems and electronic health record systems (i.e., Point Click Care or similar platforms). (Required)
• Hands-on-experience with insurance verification, denial management, and claim resubmission procedures. (Required)
• Experience with accounts receivable management and payment posting processes. (Preferred)
• Working knowledge of ICD-10, CPT/HCPCS codes, and CMS billing guidelines. (Preferred)
• Previous involvement in month-end close and financial audits. (Preferred)
• Completion of the Highlands Hearthstone Ambassador training within 30 days of employment (Required)

Work Authorization/Security Clearances:

• Medical Screening
• Criminal History Clearance
• FBI Fingerprint Clearance (Only required if you have not lived in PA for the last 2 years)
• Immigration and naturalization (I-9) Clearance

Physical Requirements and Physical Demands:

• While performing the duties of this job, the employee is regularly required to talk, hear, write and see. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
• This position continuously requires sitting.
• This position requires bending, balancing, reaching above shoulder, and pushing/pulling (up to 25 lbs.).
• This position occasionally requires standing, walking, climbing, bending, reaching above head, reaching above shoulder, lifting from floor level up, lifting from waist level up, lifting 25 lbs. maximum, and lifting and/or carrying of objects weighing up to 10 lbs.

Safety Hazards and Physical Environment:

• General office working conditions
• May be exposed to blood borne pathogens
• May be exposed to communicable diseases
• May be exposed to rare occasions during which it is necessary to interact with a resident exhibiting aggressive behavior

At-Will Employment Statement:

Employment with The Highlands at Wyomissing is on an at-will basis. This means that either the employee or the company may terminate the employment relationship at any time, with or without notice, and with or without cause, unless otherwise prohibited by law or subject to a written employment agreement signed by an authorized company representative. Nothing in this job description or any company policy shall be construed to create a contract of employment or guarantee of continued employment.