Revenue Cycle Billing Specialist

Revenue Cycle Billing Specialist - Medicaid & VA

Department: Billing
Reports To: Owners / Billing Manager
Status: Full-Time (On-Site) (Not Remote)
About Right at Home

Right at Home is a locally owned and operated home care agency proudly serving seniors, veterans, and adults with disabilities throughout Northeast and Central Nebraska. Our mission is To Improve the Quality of Life for Those We Serve , and we are committed to delivering exceptional care while creating an outstanding workplace for our employees.

We are proud to have been recognized as a Forbes Best Place to Work for three consecutive years , a reflection of our commitment to a positive workplace culture built on teamwork, accountability, compassion, and continuous improvement. If you're looking for a meaningful career where your contributions truly make an impact, we'd love to have you join our team.
Position Summary

Right at Home is seeking a highly organized, detail-oriented, and analytical Revenue Cycle Billing Specialist to oversee the complete revenue cycle for Nebraska Medicaid Waiver and Veterans Affairs (VA) billing.

This position is responsible for submitting claims through Netsmart and Optum, ensuring visit and authorization accuracy, resolving claim denials and billing exceptions, maintaining Electronic Visit Verification (EVV) compliance, coordinating documentation with internal teams, communicating with payer representatives and state agencies, and maximizing reimbursement through proactive claim management.

The Revenue Cycle Billing Specialist plays a critical role in the financial success of the agency by ensuring timely and accurate billing, reducing claim denials, improving collection rates, maintaining regulatory compliance, and identifying opportunities to strengthen billing processes.
Essential Responsibilities
Medicaid & VA Billing

• Submit Nebraska Medicaid Waiver claims accurately and timely through Netsmart.
• Submit Veterans Affairs (VA) Community Care claims accurately and timely through Optum.
• Match caregiver visits with client authorizations and supporting documentation to ensure billing accuracy.
• Review billing work queues daily for unmatched visits, missing documentation, rejected claims, and billing exceptions.
• Investigate, research, and resolve claim rejections, denials, authorization issues, and payment delays.
• Monitor claims through payment and follow up on outstanding balances.
• Maintain compliance with Nebraska Medicaid, VA, Optum, and payer billing requirements and deadlines.

EVV Compliance & Medicaid Support

• Review Medicaid visits for Electronic Visit Verification (EVV) compliance.
• Identify visits with EVV errors or missing documentation preventing billing.
• Collaborate with Recruiters, Schedulers, Care Professionals, Client Care Managers, and other office staff to obtain documentation necessary to resolve EVV and billing issues.
• Prepare and submit Force Pay Adjustment Requests for eligible Medicaid visits in accordance with Nebraska DHHS requirements.
• Track Force Pay requests through final resolution while maintaining documentation for audit purposes.
• Monitor EVV compliance trends and recommend opportunities for caregiver education and operational improvements.
• Submit weekly IVR (Interactive Voice Response) phone number approval requests to Nebraska DHHS for Medicaid clients requiring telephony verification.
• Maintain accurate documentation of IVR requests, approvals, and related client records.

Billing Resolution & External Coordination

• Serve as the primary point of contact for billing-related issues with external partners.
• Communicate with Netsmart Technical Support, Nebraska DHHS, Service Coordinators, VA Community Care Coordinators, Optum, and other payer representatives to investigate and resolve billing, authorization, and payment issues.
• Partner with Scheduling, Client Care, Payroll, Recruiting, and Billing teams to resolve documentation discrepancies affecting reimbursement.
• Document recurring billing issues and recommend workflow improvements that reduce denials, improve collections, and increase billing efficiency.

Reporting & Revenue Cycle Management

Monitor and report weekly revenue cycle performance, including:

• Medicaid claims submitted
• VA claims submitted
• First-pass claim acceptance rate
• Claims rejected or denied
• Outstanding billing issues
• Weekly collection success percentage by payer
• Accounts Receivable aging

Additional responsibilities include:

• Analyze billing trends and identify opportunities to improve reimbursement and reduce billing errors.
• Prepare regular billing and revenue cycle reports for ownership.
• Monitor overall revenue cycle health and recommend process improvements.

Additional Responsibilities

• Assist with Long-Term Care Insurance benefit verification, billing inquiries, claim submissions, follow-up, and payment resolution.
• Cross-train and support other Billing team members during periods of high workload or staff absences.
• Respond professionally to billing questions from clients, families, referral partners, and payers.
• Participate in payer training and remain current on Medicaid, VA, Optum, and billing regulation changes.
• Assist with audits, compliance reviews, and special billing projects.
• Perform other duties as assigned by the Owners.

Qualifications
Required

• High school diploma or equivalent.
• Strong computer proficiency, including Microsoft Office.
• Excellent organizational skills and attention to detail.
• Strong analytical, critical thinking, and problem-solving abilities.
• Ability to prioritize multiple tasks while meeting deadlines.
• Excellent verbal and written communication skills.
• Ability to work independently while collaborating effectively with a team.

Preferred

• Healthcare billing experience.
• Nebraska Medicaid Waiver billing experience.
• Veterans Affairs Community Care billing experience.
• Experience using Netsmart, Optum, WellSky, or similar healthcare software.
• Knowledge of Nebraska Medicaid Waiver billing requirements and Electronic Visit Verification (EVV).
• Experience with Force Pay Adjustments, IVR approvals, and home care revenue cycle management.

Knowledge, Skills & Abilities

• Exceptional attention to detail and accuracy.
• Strong analytical and critical thinking skills.
• Ability to investigate and resolve complex billing issues.
• Excellent organizational and time management skills.
• Strong customer service and professional communication skills.
• Ability to analyze billing data and identify trends.
• High level of integrity, accountability, and confidentiality.
• Collaborative approach to working with internal departments and external payer representatives.
• Commitment to continuous improvement and operational excellence.

Key Performance Indicators (KPIs)

Performance will be measured by:

• First-pass Medicaid claim acceptance rate
• First-pass VA claim acceptance rate
• Weekly collection success percentage
• Percentage of denied or rejected claims successfully remediated
• Timeliness of Medicaid and VA claim submissions
• Average resolution time for billing exceptions
• Reduction in denied and rejected claims
• Accounts Receivable aging
• Accuracy and timeliness of weekly billing reports
• Compliance with Medicaid, VA, Optum, and EVV requirements

Why Join Right at Home?

At Right at Home, we believe our employees are our greatest asset. We are committed to providing an environment where team members feel supported, appreciated, and empowered to grow professionally.

As a member of our team, you'll enjoy:

• Competitive pay based on experience and qualifications
• Comprehensive benefits package
• Paid Time Off (PTO)
• Paid Holidays
• Health, dental, and vision insurance (if applicable)
• Retirement savings opportunities (if applicable)
• Ongoing training and professional development
• Opportunities for career growth and advancement
• A supportive, collaborative team environment

As a Forbes Best Place to Work for three consecutive years , we're proud of the culture we've built-one centered on integrity, accountability, teamwork, compassion, and excellence.

As our Revenue Cycle Billing Specialist - Medicaid & VA , you'll play a vital role in maximizing reimbursement, strengthening compliance, improving operational efficiency, and supporting our continued growth while helping us serve seniors, veterans, and individuals with disabilities throughout Nebraska.