Business Office & Medical Billing Specialist

Position: Business Office & Medical Billing Specialist Location: Redmond, WA Job Id: 2575 # of Openings: 1 Emerald Communities is a mission-focused, not-for-profit organization that provides leadership for its affiliate organizations to create and enhance lifestyle opportunities for Seniors. Our Life Plan Communities include Emerald Heights in Redmond, WA, and Heron’s Key in Gig Harbor, WA. These communities are home to over 750 residents who experience exceptional environments and care where community members thrive. We are seeking a highly organized and detail-oriented Business Office & Medical Billing Specialist to ensure efficient, accurate, and timely billing and financial operations. The ideal candidate is a self-starter with a process-driven mindset, strong attention to detail, and a passion for continuous improvement. They are technically savvy, resourceful, and able to work both independently and collaboratively. This role requires excellent communication skills and the ability to build positive relationships while effectively communicating with individuals at all levels of the organization. The ideal candidate thrives in a fast-paced environment, takes ownership of their work, and is committed to operational excellence. We offer: 100% paid medical, dental and vision, employer paid life insurance and AD&D for employees working 30+ hours/week (Option to buy-up if desired). Flexible Spending account for medical and childcare reimbursements with a $500.00 rollover feature (No rollover on childcare) and option to purchase Long Term disability insurance. Eligibility begins the first of the month following 30 days of employment. Employees are able to enroll in our company’s 403(B) plan (Eligibility on 403b – 20+ hours per week). We match 50 cents for every dollar saved up to 10% of your annual salary. Matching begins the first of the quarter following 1 year of employment. Full-time employees are eligible to accrue up to 16 paid time off days, 6 paid holidays and 3 personal days. Pro-rated paid time off is available to part-time employees. In Addition, we offer: Tuition reimbursement Employee Discount Program Employee Assistant Program (EAP) through Wellspring Family Services Gym/Pool Free Parking Free meal Beautiful walking paths around the community Wage: $33–$35/hour , depending on experience. Hours: Monday–Friday, general business hours. Primary Responsibilities Billing & Revenue Cycle Management Manage full-cycle billing and collections for Medicare Part A and Part B, Medicaid, HMOs, commercial, hospice, and private pay. Access the Medicare Common Working File (CWF) to verify eligibility, benefit days, and spell-of-illness. Submit timely, coded claims to primary and secondary payers and aggressively appeal denials. Coordinate the month-end "Triple Check" process with clinical and billing teams. Process payments, post line items, and adjust transfers of responsibility. Managed Care & Authorizations Secure prior authorizations from managed care plans before or upon admission. Submit clinical updates to insurance case managers to secure re-authorizations and prevent gaps. Monitor approved dates, levels of care, and exclusions; communicate parameters to clinical and therapy teams. Participate in daily and weekly interdisciplinary team meetings to monitor the progress of patients. Oversee the timely execution, documentation, and retention of SNF ABNs for residents exhausting or terminating skilled care benefits and provide financial liability information to patients after skilled services terminate. Financial & Administrative Operations Complete daily, weekly, and monthly census reconciliations in coordination with the Health Information Department. Verify insurance benefits for new admissions and serve as the primary external liaison. Work with Accounts Receivable to process and manage Long-Term Care Insurance claims. Route vendor invoices, manage office supplies, and support on-site payroll/HR workflows. Education & Experience 2–3 years of experience in medical billing and business office operations. High School Diploma required; Associate's or Bachelor's degree in Healthcare Administration preferred. Knowledge, Skills & Abilities Proficient with Matrix 360 (preferred) and MS Office. Expert understanding of CMS guidelines, Medicare, Medicaid, and managed care rules. High attention to detail, strong organization, and strict HIPAA compliance. Ability to manage across multiple campuses and work seamlessly with finance and healthcare teams. All Emerald Communities employees must pass a criminal background check and other pre-employment requirements. We are an E-Verify employer. Emerald Communities is an equal opportunity employer. #J-18808-Ljbffr Emerald Heights