Managed Care Biller

Cantex Continuing Care Network•Carrollton, TX

21h•Onsite

About The Position

The Managed Care / Medicare Billing Specialist is responsible for managing the accounts receivable, billing, claims processing, collections, and reimbursement functions for multiple Skilled Nursing Facilities (SNFs) throughout Texas. This role focuses on optimizing the managed care and Medicare revenue cycle by ensuring accurate claims submission, timely reimbursement, denial resolution, payment posting, and regulatory compliance. The Managed Care / Medicare Billing Specialist serves as a key contributor to revenue cycle performance by improving cash flow, reducing aging accounts receivable, minimizing claim denials, and supporting overall financial health. This position requires expertise in Medicare Part A billing, managed care billing, insurance claims processing, and long‑term care reimbursement.

Requirements

High school diploma required; college degree or equivalent advanced coursework preferred
Prior managed care and Medicare billing experience in a Skilled Nursing Facility (SNF) environment required
Strong knowledge of healthcare billing software, including American HealthTech (AHT) and/or HealthMEDX Vision preferred
Understanding of Medicare Part A billing, managed care billing, reimbursement methodologies, and long‑term care revenue cycle operations
Knowledge of ICD‑9 and ICD‑10 diagnosis coding principles
Ability to prioritize workload, manage multiple deadlines, and work efficiently in a fast‑paced environment
Strong analytical, organizational, customer service, and communication skills
Team‑oriented mindset with willingness to support other areas of medical billing and accounts receivable

Nice To Haves

college degree or equivalent advanced coursework preferred
Strong knowledge of healthcare billing software, including American HealthTech (AHT) and/or HealthMEDX Vision preferred

Responsibilities

Process monthly managed care and Medicare Part A claims for multiple Skilled Nursing Facilities
Create, submit, track, and reconcile managed care and Medicare claims
Analyze, research, and resolve denied, rejected, or underpaid claims
Verify Medicare eligibility, benefit periods, skilled coverage days, and payer requirements
Post payments and ensure accurate reimbursement reporting
Communicate with providers, facilities, payers, and internal stakeholders regarding billing questions and claim status
Ensure all billing is accurate, complete, and compliant with federal, state, Medicare, Medicaid, and payer regulations
Coordinate third‑party billing activities with facility personnel and operational teams
Collaborate with fiscal intermediaries, auditors, cost report preparers, state agencies, federal agencies, and commercial insurance carriers
Monitor accounts receivable balances and maintain aging within established company goals
Assist with collection efforts and resolution of complex reimbursement issues
Utilize billing software to improve workflow efficiency, claim accuracy, and revenue cycle performance
Understand payer transmission requirements and ensure proper electronic claim submission
Analyze and resolve technical billing issues involving claims processing, resident accounts, reimbursement calculations, and claim transmission errors
Maintain compliance with all billing regulations, revenue cycle initiatives, and company financial management systems
Prepare and distribute billing, reimbursement, collection, and accounts receivable reports as requested
Support company DSO, cash collection, and reimbursement goals through proactive account management
Perform additional duties and special projects as assigned by the AR Manager, Director of Finance, or CFO