Sr. Billing Specialist

St. John's Senior Servi•Rochester, NY

18h•$30 - $33•Onsite

About The Position

The Senior Billing Specialist - Skilled reports directly to the Director of Revenue Cycle Management and serves as a subject matter expert for Skilled Nursing Facility (SNF) reimbursement. This position is responsible for accurate and timely billing, collections, account reconciliation, denial management, and payment posting for Medicare Part A, Medicare Advantage, Managed Care, and other third-party payers. The Senior Billing Specialist collaborates closely with clinical, MDS, rehabilitation, admissions, and finance teams to maximize reimbursement, resolve billing issues, and ensure compliance with applicable regulations and payer requirements.

Requirements

High school diploma or equivalent required
Minimum five (5) years of healthcare billing experience required
Minimum three (3) years of Skilled Nursing Facility (SNF) or long-term care (LTC) billing experience required.
Demonstrated expertise in Medicare Part A, Medicare Advantage, Managed Care and third-party payer billing.
Experience with denial management, appeals, collections, and accounts receivable follow-up.
Experience working directly with residents, families, and responsible parties regarding insurance benefits, financial obligations, and billing inquiries
Knowledge of coinsurance, copayment, deductible, and secondary insurance coordination
Ability to explain complex reimbursement and insurance information in a clear and compassionate manner
Strong analytical, organizational, and problem-solving skills
Proficient in Microsoft Excel, Word, Outlook, and billing systems.
Excellent verbal and written communication skills
Ability to work independently, prioritize multiple responsibilities and meet deadlines.
Committed to embracing and exemplifying St. John’s mission, vision, values and Brand Characteristics.
Advanced knowledge of SNF reimbursement methodologies and regulatory requirements;
Expertise in Medicare Part A and Medicare Advantage billing processes
Ability to identify reimbursement opportunities and resolve complex billing issues
Strong understanding of payer contracts, authorizations, claims edits and reimbursement rules
Ability to analyze aging reports and develop action plans to accelerate collections
Experience managing claim denials, appeals, audits and payer correspondence
Ability to educate and support team members regarding billing requirements and process improvements
Strong attention to detail while maintaining productivity and accuracy
Ability to communicate plan coverage to residents and resident families
Requires frequent sitting, standing, twisting, stooping, handling, bending and walking associated with a normal office environment.
Manual dexterity needed for using a calculator and computer keyboard.
Visual acuity required to review billing records, insurance documentation and computer screens
Ability to communicate effectively with residents, families, staff and third party payers.

Nice To Haves

Associate degree preferred
Proficiency in PointClickCare is desirable.

Responsibilities

Prepares and submits timely clean claims to various insurance companies either electronically or by paper
Responsible for co-insurance and/or co-pay billing to residents and/or responsible parties
Ensure claims are submitted timely and comply with payer-specific requirements
Review census, payer, and reimbursement information for accuracy prior to claim submission
Monitor claim status and proactively resolve billing edits, rejections, denials and underpayments
Manage appeals and reconsiderations for denied or disputed claims
Utilize accounts receivable aging reports to identify and resolve outstanding balances
Follow up with insurance carriers and managed care organizations regarding unpaid claims and reimbursement issues
Investigate payment variances and coordinate corrective actions
Collaborate with Admissions, MDS, Rehabilitation, Clinical Operations, and Finance teams to ensure accurate reimbursement
Maintain current knowledge of CMS regulations, Medicare Advantage requirements, payer guidelines and reimbursement changes
Assist in month end accounts receivable reconciliation and reporting
Identify opportunities to improve billing processes, reduce denials, and strengthen cash collections.
Serve as a resource to other billing team members regarding Medicare and Managed Care billing requirements.
Participate in audits, regulatory reviews, and special projects as assigned.
Perform other duties as assigned in support of St. John's mission, vision, and values.