Insurance Billing Specialist

Encore is seeking a highly experienced and detail-oriented Part-Time Insurance Billing Specialist to manage third-party insurance billing for three Delaware communities: Encore Parkside, Encore Wilmington, and Encore at Foulk. Payers include, but are not limited to, Medicare, Medicaid, Medicare Advantage, managed care, commercial insurance, and other third-party plans. This position is responsible for accurate, timely claim submission; insurance accounts receivable follow-up; denial resolution; and payer reconciliation. The ideal candidate is an experienced skilled-nursing biller who can work independently, identify problems before they affect cash flow, and partner effectively with community Business Office Managers and regional leadership.

ESSENTIAL JOB FUNCTIONS:

• Manage the complete billing cycle for all applicable third-party insurance payers across all three communities, including but not limited to Medicare Part A and Part B, Delaware Medicaid, Medicare Advantage, managed care, and commercial insurance.
• Review census, payer setup, authorizations, eligibility, rates, revenue codes, and supporting documentation before claims are generated and submitted.
• Prepare, scrub, and submit accurate claims within payer and timely-filing requirements; resolve claim edits, clearinghouse rejections, and submission errors promptly.
• Investigate unpaid, underpaid, rejected, and denied claims; submit corrected claims, reconsiderations, or appeals and maintain clear follow-up documentation through resolution.
• Work insurance accounts receivable aging consistently, prioritize high-dollar and timely-filing risks, and provide status updates and action plans for unresolved balances.
• Post or reconcile insurance payments, electronic remittance advice, adjustments, recoupments, and contractual balances in accordance with established processes.
• Complete month-end billing tasks and reconcile billed census, claims, payments, and outstanding balances to ensure all services are captured accurately.
• Maintain payer portal access and use PointClickCare, Inovalon, Availity, Novitasphere, state Medicaid systems, and other applicable billing platforms.
• Collaborate with Business Office Managers, Admissions, MDS, Nursing, Therapy, Medical Records, and leadership to obtain missing information and resolve billing barriers.
• Participate in insurance aging and revenue-cycle meetings, prepare requested reports, and communicate risks, trends, and needed corrections clearly.
• Monitor payer rule changes and maintain compliance with Medicare, Medicaid, HIPAA, and organizational billing policies.
• Responsibilities may be modified or expanded based on operational needs and regulatory changes.

Requirements/ Education

• Minimum five years of healthcare insurance billing experience, including at least three years of hands-on skilled-nursing insurance billing experience across multiple payer types.
• Demonstrated ability to independently manage billing and follow-up for multiple facilities, provider numbers, and payer types.
• Strong working knowledge of third-party insurance billing, including Medicare Part A and Part B, Delaware Medicaid, Medicare Advantage, managed care, commercial insurance, consolidated billing, coordination of benefits, timely filing, and denial/appeal processes.
• PointClickCare billing experience, experience with Inovalon, Availity, Novitasphere, and Medicaid payer portals is highly desirable.
• Proven experience resolving complex claim issues, underpayments, recoupments, eligibility conflicts, authorization gaps, and payer setup errors.
• High school diploma or equivalent required; associate degree or professional billing/coding certification preferred.
• Advanced attention to detail, organization, follow-through, and analytical problem-solving skills.
• Ability to work remotely with minimal supervision, manage competing deadlines, and maintain dependable availability during agreed-upon Eastern business hours.
• Excellent written and verbal communication skills and a high level of professionalism and confidentiality when handling protected health and financial information.
• Proficiency with Microsoft Excel, Outlook, and standard office technology.