Billing & Coding Specialist in Franklin, West Virginia at Pendleton Manor

• Ensure accurate and timely billing and submission of claims across Medicare, Medicare Advantage, commercial insurance, and Medicaid
• Review aged accounts receivable (AR), identify outstanding balances, and drive timely resolution and collection. (remittances, contractual adjustments, claim submission, claim resubmission, etc)
• Assisting residents and their families with the complex process of applying for long-term care Medicaid benefits and the process of “spending down” to be eligible for WV Medicaid
• Identify billing discrepancies, reimbursement delays, and potential revenue leakage, working with the appropriate team members to resolve issues.
• Submission & Follow Up of WV Medicaid Remedials & WV Medicaid Year Redeterminations
• Collaborate with internal stakeholders and facility teams to improve billing workflows, reporting accuracy, and overall accounts receivable performance.
• Help maintain consistent billing processes and financial reporting across the facilities supported by the organization.
• Monitor billing performance and identify trends, discrepancies, and opportunities to improve revenue cycle processes.
• Ensure all month-end billing reports and reporting requirements are completed accurately and on time.

Key Position Qualifications Include:

• Must have a firm understanding of the Healthcare reimbursement process, payer requirements and the fundamentals of insurance, including covered services, deductible, co-insurance, WV Medicaid, Long Term Care Insurance, Medicare A and B, and supplemental insurance
• Must have strong attention to detail and be independently driven to persevere in filing claims, and following up on denials
• Ability to meet multiple deadlines consistently and ask for assistance when needed to meet those deadlines.
• Must be able to maintain confidentiality and ensure compliance with HIPPA, federal and state rules and regulations