Billing Specialist

Job Summary

We are seeking a detail-oriented individual to manage the billing and receivables function for a company that provides home safety assessments by a Physical or Occupational Therapist and home modifications. The ideal candidate has experience in billing ancillary and/or non-medical services to Medicaid Managed Care Organizations, Medicare D-SNP and other payers, with an understanding of the unique documentation and prior authorization requirements.

Key Responsibilities

• Timely submit invoices to payers, track progress to payment, manage denials, ensure payments are accurate, apply payments and work with payers for payment disputes

• Monitor unpaid invoices, investigate rejections/denials, correct billing errors, and file appeals with payers.

• Payer Communication: Serve as the primary point of contact for payers to resolve payment discrepancies.

• Manage DSO timeframes for payments with a goal of no receivables over 90 days.

• Able to manage payer invoice submission requirements, including the ability to utilize various modalities required for invoice submission (direct to payer, through specific portals, clearinghouse, etc.)

• Documentation & Compliance: Ensure all required supporting documentation, such as bids, completed assessments, proof of completed work (photos), and client sign-off forms are attached and compliant with payer policies.

• Code Accuracy: Apply correct billing codes, HCPCS modifiers, and unit caps specific to EAA and home modification waiver programs (e.g., S codes or state-equivalent codes).

• Accounts Receivable & Denial Management:

• Reconciliation: Reconcile payments with invoice/claim and log payments accurately in the internal billing software.

• Document and Implement billing requirements for all current and new payer business.

• Manage invoices and payments to network providers

Qualifications & Requirements

• Experience: 3+ years of ancillary medical, and preferable non-medical billing and collections with MCO’s and other payer types

• Successful track record in managing billing and collections for ancillary or non-medical benefits, ensuring timely billing and payment.

• Payer Knowledge: Deep understanding of Medicaid, Medicare and dual-eligible billing guidelines and compliance requirements and direct experience with ILOS, HCBS, LTSS waiver codes

• Systems Familiarity: Proficiency with payer portals, clearinghouses, EDI systems, and billing/EHR platforms.

• Accuracy & Detail: High attention to detail regarding billing requirements, coding, modifier usage, authorization unit counts, and documentation attachment requirements.

• Communication: Strong verbal and written communication skills for interfacing internal teams, case managers and payer representatives.

Preferred Qualifications

• Direct billing experience for ancillary and community-based services

• Specialized expertise in state waiver billing rules

• Understand billing regulations and compliance with government programs

• Able to work across the organization to successfully complete required job tasks