Billing Specialist
About The Position
Extended Home Care is seeking an experienced Billing Specialist for its New Hyde Park location. This fully onsite role supports the home health revenue cycle by ensuring accurate and timely processing of claims, payments, and collections. The position focuses on resolving claim rejections and denials, reconciling payments, managing payer communications, and maintaining compliance with billing regulations and payer requirements. The Billing Specialist works with clinical and operational teams to support clean claim submission, timely reimbursement, and financial performance through proactive follow-up and account management. Success in the role includes maintaining a clean claim rate of 95% or higher, reducing DSO month over month according to RCM leadership targets, meeting first-pass payment and denial overturn rate goals, and submitting final claims within 48 hours of billable readiness. The role also requires safeguarding patient health information and complying with CMS regulations, payer requirements, and company policies.
Requirements
- At least 2 years of healthcare billing and collections experience, including hands-on DDE FISS experience.
- Strong knowledge of denials management, CARC codes, revenue codes, HCPCS codes, and Type of Bills (TOBs).
- Experience researching and resolving claim rejections and billing edits.
- Knowledge of EDI transactions, including 837I, 835, 276/277, and 999 files.
- Experience working with Managed Care payer portals.
- Strong attention to detail, a sense of urgency, and commitment to accurate claim submission.
- Excellent written documentation and organizational skills.
Nice To Haves
- Experience with McKesson or WellSky.
- Basic Excel skills for tracking KPIs, productivity, and aging reports.
Responsibilities
- Submit and manage home health claims accurately and on time.
- Work clearinghouse rejections daily by researching issues, correcting errors, and resubmitting claims until they are processed and paid.
- Track and resolve claim edits, denials, and reason codes, including duplicate claims, overlap issues, and provider- or facility-related edits.
- Reconcile claims, payments, and adjustments from 835 files, and escalate unresolved variances or denials.
- Manage Managed Care and commercial claims through payer portals and clearinghouses, making corrections and resubmissions as needed.
- Collaborate with Clinical Intake, Coding, QA, and Clinical Operations teams to ensure billable readiness, including signed orders, completed visit documentation, locked OASIS assessments, and supporting clinical documentation.
- Monitor and prevent late claims, document root causes, and request exceptions when appropriate.
- Maintain organized worklists, aging reports, and account follow-up notes with clear next steps.
- Safeguard patient health information and comply with CMS regulations, payer requirements, and company policies.
- Meet role success metrics, including clean claim rate, DSO, first-pass payment rate, denial overturn rate, and claim submission timelines.
Benefits
- Health insurance
- Dental insurance
- Vision insurance
- Life insurance
- 401(k) with company match
- Paid holidays
- PTO package
- Paid orientation
- Employee Referral Program
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
