Billing Specialist

Overview

A healthcare organization is seeking a full-time Medical Billing Specialist to join their Revenue Cycle Management team. This role focuses on billing home health and waiver services accurately and in compliance with Medicare, Medicaid, commercial, private insurance, payer, and agency requirements. The position reports to the RCM Supervisor and operates Monday through Friday, 8:00 am to 5:00 pm EST.

Responsibilities

• Prepare and submit clean claims to support maximum appropriate reimbursement.
• Post payments, monitor accounts receivable (AR), resolve denials, and reduce preventable billing delays.
• Verify eligibility, authorizations, electronic visit verification (EVV) records, service units, payer rules, and documentation before billing or resubmission.
• Collaborate with clinical, administrative, referral, authorization, and leadership teams to resolve documentation, claim, payer, and account issues.
• Maintain accurate billing documentation including records of billing actions, denials, appeals, resubmissions, account updates, payment follow-up, and payer communications.
• Document detailed account notes such as dates of service, payer representative contacts, call reference numbers, authorizations, appeal/dispute numbers, actions taken, and next follow-up steps.
• Ensure billing system, payer portal, and electronic medical record (EMR/EHR) updates are complete, timely, and consistent with agency procedures.
• Maintain HIPAA compliance and protect all patient, payer, employee, and agency information.
• Assist with special projects, startup support, workflow development, payer process updates, and cross-department communication as assigned.

Required Qualifications

• High school diploma or GED preferred.
• Two or more years of healthcare billing experience, preferably in revenue cycle, home health, waiver services, Medicaid, Medicare, or insurance billing.
• Experience with Direct Data Entry (DDE) and Waystar systems preferred, including understanding claim flow between these platforms.
• Knowledge of Patient-Driven Groupings Model (PDGM), Low Utilization Payment Adjustments (LUPAs), and their impact on claims and accounts receivable.
• Experience with Medicaid waiver billing, EVV, denial management, AR follow-up, payment posting, payer portals, or authorization workflows preferred.
• Proficiency in medical terminology preferred.
• Strong computer skills and ability to work accurately across multiple software systems.

Technical Competencies

• Understanding of claim submission processes, payer requirements, remittance review, denial correction, appeals, AR follow-up, write-offs, and billing compliance.
• Ability to review authorizations, eligibility, service units, EVV data, payer rules, and documentation for billing readiness.
• Capability to generate, review, and explain billing, denial, AR, payment, and monthly reporting information.
• Proficient in using general office equipment including multi-line phones, fax machines, copiers, scanners, and computer software.

Behavioral Competencies

• Detail-oriented with strong analytical, reconciliation, and problem-solving skills.
• Organized and able to manage multiple accounts, payers, deadlines, tasks, and follow-up priorities.
• Professional communicator with payers, clients, care managers, clinical staff, leadership, and billing team members.
• Adaptable and willing to cross-train across home health, waiver services, payer types, and new agency processes.
• Team-focused, dependable, and able to assist other billing staff as agency needs change.
• Courteous, compassionate, respectful, and positive when working with internal and external customers.

Work Environment

• Remote or office-based work as assigned.
• Frequent computer use, phone communication, data entry, payer portal activity, document review, and account follow-up.
• Must manage deadlines, interruptions, payer follow-up, competing priorities, and confidential information while maintaining accuracy and professionalism.
• Equipment and software used include EMR/EHR, billing systems, payer portals, DDE, Waystar, iQIES, EVV platforms, Microsoft Office or similar applications, multi-line telephone, fax, copier, and scanner.

Equal Opportunity

The employer is an equal opportunity organization committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, national origin, age, disability, veteran status, or any other protected status under applicable law.