Billing Specialist

Job Summary We are seeking a detail-oriented individual to manage the billing and receivables function for a company that provides home safety assessments by a Physical or Occupational Therapist and home modifications. The ideal candidate has experience in billing ancillary and/or non-medical services to Medicaid Managed Care Organizations, Medicare D-SNP and other payers, with an understanding of the unique documentation and prior authorization requirements. Key Responsibilities Timely submit invoices to payers, track progress to payment, manage denials, ensure payments are accurate, apply payments and work with payers for payment disputes Monitor unpaid invoices, investigate rejections/denials, correct billing errors, and file appeals with payers. Payer Communication : Serve as the primary point of contact for payers to resolve payment discrepancies. Manage DSO timeframes for payments with a goal of no receivables over 90 days. Able to manage payer invoice submission requirements, including the ability to utilize various modalities required for invoice submission (direct to payer, through specific portals, clearinghouse, etc.) Documentation & Compliance: Ensure all required supporting documentation, such as bids, completed assessments, proof of completed work (photos), and client sign-off forms are attached and compliant with payer policies. Code Accuracy: Apply correct billing codes, HCPCS modifiers, and unit caps specific to EAA and home modification waiver programs (e.g., S codes or state-equivalent codes). Accounts Receivable & Denial Management: Reconciliation: Reconcile payments with invoice/claim and log payments accurately in the internal billing software. Document and Implement billing requirements for all current and new payer business. Manage invoices and payments to network providers Qualifications & Requirements Experience: 3+ years of ancillary medical, and preferable non-medical billing and collections with MCO’s and other payer types Successful track record in managing billing and collections for ancillary or non-medical benefits, ensuring timely billing and payment. Payer Knowledge: Deep understanding of Medicaid, Medicare and dual-eligible billing guidelines and compliance requirements and direct experience with ILOS, HCBS, LTSS waiver codes Systems Familiarity: Proficiency with payer portals, clearinghouses, EDI systems, and billing/EHR platforms. Accuracy & Detail: High attention to detail regarding billing requirements, coding, modifier usage, authorization unit counts, and documentation attachment requirements. Communication: Strong verbal and written communication skills for interfacing internal teams, case managers and payer representatives. Preferred Qualifications Direct billing experience for ancillary and community-based services Specialized expertise in state waiver billing rules Understand billing regulations and compliance with government programs Able to work across the organization to successfully complete required job tasks