Business Office & Medical Billing Specialist

Emerald Communities•Redmond, WA

6d•Onsite

About The Position

Emerald Communities is seeking a highly organized and detail-oriented Business Office & Medical Billing Specialist to ensure efficient, accurate, and timely billing and financial operations. The ideal candidate is a self-starter with a process-driven mindset, strong attention to detail, and a passion for continuous improvement. They are technically savvy, resourceful, and able to work both independently and collaboratively. This role requires excellent communication skills and the ability to build positive relationships while effectively communicating with individuals at all levels of the organization. The ideal candidate thrives in a fast-paced environment, takes ownership of their work, and is committed to operational excellence.

Requirements

2–3 years of experience in medical billing and business office operations.
High School Diploma required.
Proficient with Matrix 360 (preferred) and MS Office.
Expert understanding of CMS guidelines, Medicare, Medicaid, and managed care rules.
High attention to detail, strong organization, and strict HIPAA compliance.
Ability to manage across multiple campuses and work seamlessly with finance and healthcare teams.
Must pass a criminal background check and other pre-employment requirements.

Nice To Haves

Associate's or Bachelor's degree in Healthcare Administration preferred.

Responsibilities

Manage full-cycle billing and collections for Medicare Part A and Part B, Medicaid, HMOs, commercial, hospice, and private pay.
Access the Medicare Common Working File (CWF) to verify eligibility, benefit days, and spell-of-illness.
Submit timely, coded claims to primary and secondary payers and aggressively appeal denials.
Coordinate the month-end "Triple Check" process with clinical and billing teams.
Process payments, post line items, and adjust transfers of responsibility.
Secure prior authorizations from managed care plans before or upon admission.
Submit clinical updates to insurance case managers to secure re-authorizations and prevent gaps.
Monitor approved dates, levels of care, and exclusions; communicate parameters to clinical and therapy teams.
Participate in daily and weekly interdisciplinary team meetings to monitor the progress of patients.
Oversee the timely execution, documentation, and retention of SNF ABNs for residents exhausting or terminating skilled care benefits and provide financial liability information to patients after skilled services terminate.
Complete daily, weekly, and monthly census reconciliations in coordination with the Health Information Department.
Verify insurance benefits for new admissions and serve as the primary external liaison.
Work with Accounts Receivable to process and manage Long-Term Care Insurance claims.
Route vendor invoices, manage office supplies, and support on-site payroll/HR workflows.

Benefits

100% paid medical, dental and vision
employer paid life insurance and AD&D for employees working 30+ hours/week
Flexible Spending account for medical and childcare reimbursements with a $500.00 rollover feature
option to purchase Long Term disability insurance
403(B) plan
company match for 403(B) plan
up to 16 paid time off days for full-time employees
6 paid holidays
3 personal days
Pro-rated paid time off for part-time employees
Tuition reimbursement
Employee Discount Program
Employee Assistant Program (EAP) through Wellspring Family Services
Gym/Pool access
Free Parking
Free meal