Billing Resolution Specialist

COMMONWEALTH CARE OF ROANOKE•Cave Spring, VA

1d•Hybrid

About The Position

JOB SUMMARY: The Billing Resolution Specialist is responsible for auditing resident accounts, reconciling billed and unbilled charges, resolving technical claim denials, and submitting corrections to ensure maximum reimbursement and compliance with payer and regulatory requirements. The Billing Resolution Specialist works closely with the billing team, business office, Billing Manager, AR System Specialist and clinical teams to resolve complex billing issues and identify process gaps that impact revenue. This position also includes assisting in training and onboarding new billing staff.

Requirements

High school diploma or equivalent required; associate degree in healthcare administration, accounting, or related field preferred.
Minimum 5 years of SNF or long‑term care billing experience, with a strong reconciliation background.
Working knowledge of Medicare A, Medicaid, and managed care billing in a SNF setting.
Experience researching denials and submitting corrected or late claims.
Strong attention to detail and analytical skills.

Nice To Haves

Experience with SNF billing systems (e.g., PCC or similar platforms).
Knowledge of benefit exhaust processes and no‑pay claim requirements.
Ability to manage multiple accounts and prioritize work in a deadline‑driven environment.
Strong written and verbal communication skills.
Ability to work independently while collaborating with cross‑functional teams.

Responsibilities

Assist with complex billing corrections, including rebills, adjustments, and payer‑specific requirements.
Audit resident accounts to verify charges, payments, and balances are accurate and complete.
Perform detailed account reconciliation between the billing system and payer remittances by researching residual account balances.
Identify missing charges, billing discrepancies, and posting errors, and take corrective action.
Research and analyze insurance claim denials to determine root cause.
Collaborate with internal teams to correct documentation, coding, or billing issues contributing to denials.
Prepare and submit corrected claims or supporting documentation to payers.
Track recurring denial trends and report findings to leadership.
Work closely with Business Office staff, billers, and leadership to resolve billing and reconciliation issues.
Maintain compliance with Medicare, Medicaid (Virginia), and commercial insurance regulations.
Follow internal billing policies and procedures to support audit readiness and compliance.