Billing Specialist (Skilled Nursing Insurance Billing - Medicare, Medicaid)

We are seeking a highly skilled and detail-oriented Billing Specialist with expertise in insurance billing within the skilled nursing or long-term care setting. The ideal candidate will have hands-on experience managing claims for various types of insurance, including Medicare, Medicaid, private insurance, and Managed Care plans, while ensuring compliance with industry regulations. This role is essential for ensuring accurate billing, timely reimbursement, and efficient handling of claims to support the financial health of the skilled nursing facility.

Key Responsibilities:

• Submit, track, and follow up on insurance claims for skilled nursing services to various insurers, including Medicare, Medicaid, Managed Care plans, and private insurance.
• Review patient information, verify eligibility, and ensure proper documentation is in place for all claims submissions.
• Ensure accurate coding of services using appropriate ICD-10, CPT, and HCPCS codes specific to skilled nursing care.
• Work closely with healthcare providers and clinical staff to ensure that billing documentation reflects accurate and appropriate services rendered.
• Respond to and resolve insurance claim denials, rejections, and underpayments in a timely manner, ensuring prompt follow-up and appeal submissions when necessary.
• Communicate effectively with insurance representatives, patients, and families to resolve billing-related issues.
• Monitor and maintain aging reports for outstanding claims and ensure prompt resolution to minimize delays in reimbursement.
• Ensure compliance with Medicare/Medicaid billing requirements, regulatory standards, and facility-specific protocols.
• Reconcile accounts, process patient statements, and maintain billing records in accordance with company policy and HIPAA regulations.
• Collaborate with the finance team to provide insights on billing trends, revenue cycle management, and financial reporting.
• Stay current on changes in billing regulations, including updates related to Medicare, Medicaid, and Managed Care plans.
• Maintain strict confidentiality of patient and financial information as required by HIPAA and other regulatory standards.

• Proven experience as a Billing Specialist, specifically in a skilled nursing, long-term care, or similar healthcare setting.
• Knowledge of insurance verification, coding, and claims submission specific to skilled nursing, including Medicare, Medicaid, and Managed Care.
• Familiarity with skilled nursing billing procedures, including SNF-specific regulations and reimbursement methodologies (e.g., RUGs, PDPM).
• Proficient in ICD-10, CPT, and HCPCS coding for skilled nursing services.
• Knowledge of healthcare compliance regulations and HIPAA requirements.
• Proficiency in Microsoft Office Suite
• High school diploma or general education degree (GED) is required; certification in medical billing (e.g., CBCS, CPB) preferred.