Sr. Billing Specialist in Rochester, New York at St Johns Health Care Corporation

Job title: Senior Billing Specialist

Position Summary: The Billing Specialist position reports directly to the Director of Finance and will work within a team environment to complete submissions, follow up on rejections and post payments for Medicare and other third-party payers.

Qualifications & Education Required:

• High school diploma or equivalent required; Associate degree preferred
• Minimum five (5) years of healthcare billing experience required
• Minimum three (3) years of Skilled Nursing Facility (SNF) or long-term care (LTC) billing experience required.
• Demonstrated expertise in Medicare Part A, Medicare Advantage, Managed Care and third-party payer billing.
• Experience with denial management, appeals, collections, and accounts receivable follow-up.
• Experience working directly with residents, families, and responsible parties regarding insurance benefits, financial obligations, and billing inquiries
• Knowledge of coinsurance, copayment, deductible, and secondary insurance coordination
• Ability to explain complex reimbursement and insurance information in a clear and compassionate manner
• Strong analytical, organizational, and problem-solving skills
• Proficient in Microsoft Excel, Word, Outlook, and billing systems. Proficiency in PointClickCare is desirable.
• Excellent verbal and written communication skills
• Ability to work independently, prioritize multiple responsibilities, and meet deadlines.
• Committed to embracing and exemplifying St. John’s mission, vision, values, and Brand Characteristics.

Core Organizational Competencies:

• St. John’s Brand Characteristics - Embrace living by being Friendly, Respectful, Responsive, Compassionate, Innovative and Fun towards elders, families, and colleagues.
• Teamwork - Actively participates. Assists team members; offers encouragement. Acknowledges/welcomes elders. Keeps team members informed. Recognizes achievements and efforts of others.
• Job Knowledge - Consistently demonstrates working knowledge of all aspects of job. Remains current on job-related changes and trends.
• Planning/Organization - Demonstrates initiative; plans appropriately. Uses time, materials, and resources effectively. Organizes work to ensure commitment and priorities.
• Productivity - Consistently maintains high activity and efficiently produces acceptable volume of work. Consistently meets deadlines and commitments.
• Quality - Consistently produces accurate, timely work which meets required quality standards. Pays attention to detail. Sets high standards of performance for self and actively seeks continuous improvement. Provides elder-driven care.
• Reliability - Consistently delivers on commitments. Can be counted on to accomplish tasks without follow-up. Available when required by elder or team and can be counted on to help or assist when needed. Responds in a timely manner.
• Demeanor (attitude) - Embraces change with optimism. Addresses concerns appropriately. Positively communicates. Good listener. Consistently maintains a positive demeanor.

Position Competencies:

• Advanced knowledge of SNF reimbursement methodologies and regulatory requirements;
• Expertise in Medicare Part A and Medicare Advantage billing processes
• Ability to identify reimbursement opportunities and resolve complex billing issues
• Strong understanding of payer contracts, authorizations, claims edits and reimbursement rules
• Ability to analyze aging reports and develop action plans to accelerate collections
• Experience managing claim denials, appeals, audits and payer correspondence
• Ability to educate and support team members regarding billing requirements and process improvements
• Strong attention to detail while maintaining productivity and accuracy
• Ability to communicate plan coverage to residents and resident families

Position Responsibilities:

• Prepares and submits timely clean claims to various insurance companies either electronically or by paper
• Responsible for co-insurance and/or co-pay billing to residents and/or responsible parties
• Ensure claims are submitted timely and comply with payer-specific requirements
• Review census, payer, and reimbursement information for accuracy prior to claim submission
• Monitor claim status and proactively resolve billing edits, rejections, denials and underpayments
• Manage appeals and reconsiderations for denied or disputed claims
• Utilize accounts receivable aging reports to identify and resolve outstanding balances
• Follow up with insurance carriers and managed care organizations regarding unpaid claims and reimbursement issues
• Investigate payment variances and coordinate corrective actions
• Collaborate with Admissions, MDS, Rehabilitation, Clinical Operations, and Finance teams to ensure accurate reimbursement
• Maintain current knowledge of CMS regulations, Medicare Advantage requirements, payer guidelines and reimbursement changes
• Assist in month end accounts receivable reconciliation and reporting
• Identify opportunities to improve billing processes, reduce denials, and strengthen cash collections.
• Serve as a resource to other billing team members regarding Medicare and Managed Care billing requirements.
• Participate in audits, regulatory reviews, and special projects as assigned.
• Perform other duties as assigned in support of St. John's mission, vision, and values.

Physical Requirements:

• Requires frequent sitting, standing, twisting, stooping, handling, bending and walking associated with a normal office environment. Manual dexterity needed for using a calculator and computer keyboard.

Exposure to Conditions:

• May be exposed to infectious diseases. Exposed to physical aggression.