Senior Homecare Billing Specialist in Minnetonka, Minnesota at SERVICE MANAGEMENT GROUP INC

The Senior Homecare Billing Specialist is responsible for preparing, daily, monthly, and quarterly review of Accounts Receivable and Revenue and Receivable analysis and for preparing, submitting, and managing billing claims to Minnesota DHS and managed care organizations to ensure accurate and timely reimbursement for homecare services. This role reviews client eligibility, verifies authorization details, submits claims, monitors payment status, and proactively follows up to resolve denials, discrepancies, or delays in processing.

The Senior Homecare Billing Specialist serves as a key liaison between internal teams, payer representatives, and state systems, ensuring all billing documentation is complete, compliant, and submitted within required timeframes. They maintain detailed records, research unpaid claims, escalate issues when necessary, and ensure billing workflows are consistently aligned with regulatory and payer-specific requirements.

Success in this role requires strong analytical skills, attention to detail, and the ability to manage a high volume of claims with accuracy and consistency. The ideal candidate is organized, deadline driven, and comfortable navigating payer portals, MNITS, and billing software systems.

This position plays a critical role in supporting organizational revenue, ensuring compliance with state and payer regulations, and maintaining uninterrupted financial operations for homecare services.

Main Duties:

Billing & Claims Processing

• Prepare, submit, and track timely and accurate electronic claims to DHS, Medicare/Medicaid managed care organizations, and commercial insurance payers.
• Ensure that claims reflect correct service codes, units, modifiers, and authorization of information specific to homecare programs.
• Verify client eligibility regularly using MN ITS and payer portals.
• Process resubmissions, voids, and adjustments as needed to correct billing discrepancies.

Authorization Management

• Review authorization details (units, dates, service types) prior to billing to prevent claim denials.
• Submit initial, concurrent, and renewal authorization requests to state agencies and MCOs.
• Monitor authorization status and follow up frequently to ensure timely approval.
• Track expiration dates and ensure renewals are submitted in advance to prevent service gaps.
• Respond to payer requests for additional information, corrections, or clarifications.
• Research and resolve issues related to missing, incorrect, or denied authorizations.

Denial Management & Follow-Up

• Research unpaid or rejected claims and take corrective actions to secure reimbursement.
• Communicate with payer representatives to resolve complex billing issues.
• Document all follow-up activities in billing systems and ensure timely escalation when payment barriers arise.

Eligibility & Compliance

• Verify client eligibility, plan type, and benefits coverage through state systems, MCO portals, or eligibility tools.
• Ensure service authorizations align with regulatory requirements, plan limits, and clinical guidelines.
• Maintain compliance with DHS, HIPAA, and payer-specific regulations for homecare billing.
• Assist in internal audits and respond to payer audit requests with accurate documentation.

Collaboration and Communication

• Required to work collaboratively with the Homesura Operations Department to ensure consistent alignment on policies and billing procedures.
• Work closely with Intake, Scheduling, and Case Management to ensure accurate billing data.
• Provide clear communication to internal staff regarding billing requirements, updates, and identified issues.
• Deliver professional and timely customer service to caregivers, clients, and external partners.

Documentation & Recordkeeping

• Daily, monthly, and quarterly review of Accounts Receivable
• Monthly reports Account Receivable analysis
• Maintain accurate and timely records of all authorization requests, approvals, denials, and renewals.
• Track reimbursement trends and notify leadership of systemic issues impacting payments.
• Assist with month-end billing reconciliation tasks as assigned.
• All other duties as assigned.

• High school diploma or equivalent required. Associate degree in Human Services (or similar) preferred.
• 5-10 years of experience in healthcare authorization, medical office administration, billing, case management, or payer coordination.
• Experience using state authorization systems, payer portals, or managed care platforms.
• Strong attention to detail and accuracy with documentation.
• Excellent follow-through and ability to manage multiple tasks and deadlines.
• Strong communication skills and professional phone/email etiquette.
• Ability to work independently and collaborate with multidisciplinary teams.
• Experience with Medicaid, managed care plans, waivers, or state-funded programs.
• Familiarity with clinical documentation, service codes, and prior authorization regulations.
• Knowledge of HIPAA, healthcare privacy requirements, and payer authorization rules preferred
• Experience in high-volume or fast-paced authorization environments.
• Must pass a background study with the Minnesota Department of Human Services.
• All employees working remotely will be required to adhere to company remote work policies.

Competency’s Needed:

• Action Oriented: Works hard, is action oriented and full of energy for challenges; not fearful of acting with a minimum of planning to seize opportunities.
• Drive for Results: can be counted on to exceed goals successfully; is bottom-line oriented, steadfastly pushes self and others for results.
• Integrity and Trust: is widely trusted, seen as direct, truthful and can present the truth in an appropriate and helpful manner, keeps confidences, admits mistakes, does not misrepresent self for personal gain.
• Follow-Through: Persistent and proactive in monitoring authorization status.
• Detail Orientation: Accurate data entry, documentation, and record keeping.
• Communication: Clear, professional interaction with payers and internal teams.
• Problem-Solving: Investigates denials, delays, and discrepancies effectively.
• Time Management: Meets tight deadlines and handles large caseloads.
• Accountability: Owns the process from submission through approval.
• Confidentiality: Handles sensitive information with professionalism.