Sr. Billing Specialist

Senior Billing Specialist - SkilledThe 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.Qualifications & Education RequiredHigh school diploma or equivalent required; Associate degree preferredMinimum five (5) years of healthcare billing experience requiredMinimum 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 inquiriesKnowledge of coinsurance, copayment, deductible, and secondary insurance coordinationAbility to explain complex reimbursement and insurance information in a clear and compassionate mannerStrong analytical, organizational, and problem-solving skillsProficient in Microsoft Excel, Word, Outlook, and billing systems. Proficiency in PointClickCare is desirable.Excellent verbal and written communication skillsAbility to work independently, prioritize multiple responsibilities and meet deadlines.Committed to embracing and exemplifying St. John's mission, vision, values and Brand Characteristics.Core Organizational CompetenciesSt. John's Brand Characteristics - Embrace living by being Friendly, Respectful, Responsive, Compassionate, Innovative and Fun towards elders, families and colleagues.Teamwork - Actively participates. Assists team members; offers encouragement. Acknowledges/welcomes elders. Keeps team members informed. Recognizes achievements and efforts of others.Job Knowledge - Consistently demonstrates working knowledge of all aspects of job. Remains current on job related changes and trends.Planning/Organization - Demonstrates initiative; plans appropriately. Uses time, materials, resources effectively. Organizes work to ensure commitment and priorities.Productivity - Consistently maintains high activity and efficiently produces acceptable volume of work. Consistently meets deadlines and commitments.Quality - Consistently produces accurate, timely work which meets required quality standards. Pays attention to detail. Sets high standards of performance for self and actively seeks continuous improvement. Provides elder-driven care.Reliability - Consistently delivers on commitments. Can be counted on to accomplish tasks without follow up. Available when required by elder or team and can be counted on to help or assist when needed. Responds in a timely manner.Demeanor (attitude) - Embraces change with optimism. Addresses concerns appropriately. Positively communicates. Good listener. Consistently maintains a positive demeanor.Position Competencies:Advanced knowledge of SNF reimbursement methodologies and regulatory requirements;Expertise in Medicare Part A and Medicare Advantage billing processesAbility to identify reimbursement opportunities and resolve complex billing issuesStrong understanding of payer contracts, authorizations, claims edits and reimbursement rulesAbility to analyze aging reports and develop action plans to accelerate collectionsExperience managing claim denials, appeals, audits and payer correspondenceAbility to educate and support team members regarding billing requirements and process improvementsStrong attention to detail while maintaining productivity and accuracyAbility to communicate plan coverage to residents and resident familiesPosition Responsibilities:Prepares and submits timely clean claims to various insurance companies either electronically or by paperResponsible for co-insurance and/or co-pay billing to residents and/or responsible partiesEnsure claims are submitted timely and comply with payer-specific requirementsReview census, payer, and reimbursement information for accuracy prior to claim submissionMonitor claim status and proactively resolve billing edits, rejections, denials and underpaymentsManage appeals and reconsiderations for denied or disputed claimsUtilize accounts receivable aging reports to identify and resolve outstanding balancesFollow up with insurance carriers and managed care organizations regarding unpaid claims and reimbursement issuesInvestigate payment variances and coordinate corrective actionsCollaborate with Admissions, MDS, Rehabilitation, Clinical Operations, and Finance teams to ensure accurate reimbursementMaintain current knowledge of CMS regulations, Medicare Advantage requirements, payer guidelines and reimbursement changesAssist in month end accounts receivable reconciliation and reportingIdentify 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.Physical Requirements: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 screensAbility to communicate effectively with residents, families, staff and third party payers.Exposure to Conditions:Normal office environment within a healthcare setting. Potential exposure to infectious diseases and other health-related conditions.