Billing Specialist

ALL•Wyomissing, PA

21h

About The Position

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).

Requirements

High school Diploma or GED (Required)
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)
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.
Completion of the Highlands Hearthstone Ambassador training within 30 days of employment (Required)
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

Nice To Haves

Associate degree: Business or Accounting (Preferred)
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)

Responsibilities

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.
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.
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.
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.
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.
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.