Insurance Billing Specialist

Job Description

Job Description

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.