Billing Specialist

Valence-Care; Village of New Hyde Park (NY); On-site; USD 52,000 - 60,000; Full time

Benefits offered by this job

Health

Dental

Vision

Life Insurance

401k + Company match

Paid holidays

PTO package

Paid orientation

Employee Referral Program

Job summary

Valence-Care in New Hyde Park, NY is seeking a Billing Specialist to support revenue cycle for home health claims. You will ensure timely processing, manage denials, and collaborate with clinical and operations teams to maintain compliant, accurate billing.

The role emphasizes proactive follow-up, clean claim submission, and maintaining payer relationships through portals and EDI tools. A background in home health billing and 2+ years experience is preferred; on-site work at 100% is required.

Qualifications

• 2+ years of healthcare billing and collections experience with hands-on DDE FISS experience.
• Strong knowledge of denials management, CARC codes, revenue codes, HCPCS codes, and TOBs.
• Experience researching and resolving claim rejections and billing edits.
• Knowledge of EDI transactions, including 837I, 835, 276/277, and 999 files.
• Experience working with Managed Care payer portals.
• Attention to detail, sense of urgency, and commitment to accurate claim submission.
• Excellent written documentation and organizational skills.

Responsibilities

• Submit and manage home health claims accurately and timely.
• Research and correct clearinghouse rejections; resubmit until paid.
• Track edits, denials, and reason codes; fix duplicates and overlaps.
• Reconcile 835 payments and adjustments; resolve variances.
• Handle Managed Care and commercial claims via payer portals.
• Coordinate with Clinical teams to ensure billable readiness.
• Monitor late claims; document root causes and request exceptions.
• Maintain worklists, aging reports, and follow-up notes.
• Protect PHI and comply with CMS, payer requirements, and policies.

Skills

Healthcare billing & collections

Denials management & CARC

EDI transactions

Payer portals (Managed Care)

Attention to detail

Documentation

Tools

McKesson

WellSky

Job description

Billing Specialist

Extended Home Care is seeking an experienced Billing Specialist to work at our New Hyde Park location.

Location: 100% On-Site

Pay: $25.00 to $29.00 Hourly

Job Position Summary

The Home Health Billing Professional I is responsible for supporting the revenue cycle by ensuring the accurate and timely processing of home health claims, payments, and collections. This role focuses on resolving claim rejections and denials, reconciling payments, managing payer communications, and maintaining compliance with billing regulations and payer requirements. Working closely with both clinical and operational teams, the position helps drive clean claim submission, timely reimbursement, and overall financial performance through proactive follow-up and effective account management.

Key Responsibilities

• Submit and manage home health claims accurately and timely.
• Work clearinghouse rejections daily by researching issues, correcting errors, and resubmitting claims until fully processed and paid.
• Track and resolve claim edits, denials, and reason codes, including duplicate claims, overlap issues, and provider/facility-related edits.
• Reconcile claims, payments, and adjustments from 835 files and escape unresolved variances or denials.
• Manage Managed Care and commercial claims through payer portals and clearinghouses, making corrections and resubmissions as necessary.
• Collaborate with Clinical Intake, Coding, QA, and Clinical Operations teams to ensure billable readiness, including signed orders, completed visit documentation, locked OASIS assessments, and supporting clinical documentation.
• Monitor and prevent late claims while documenting root causes and request exceptions when appropriate.
• Maintain organized worklists, aging reports, and account follow-up notes with clear next steps.
• Safeguard patient health information (PHI) and comply with CMS regulations, payer requirements, and company policies.

Qualifications

• 2+ years of healthcare billing and collections experience with hands-on DDE FISS experience.
• Strong knowledge of denials management, CARC codes, revenue codes, HCPCS codes, and Type of Bills (TOBs).
• Experience researching and resolving claim rejections and billing edits.
• Knowledge of EDI transactions, including 837I, 835, 276/277, and 999 files.
• Experience working with Managed Care payer portals.
• Strong attention to detail, sense of urgency, and commitment to accurate claim submission.
• Excellent written documentation and organizational skills.

Preferred Qualifications

• Experience with McKesson, WellSky a plus.
• Basic Excel skills for tracking KPIs, productivity, and aging reports.

Tools & Systems

• Payer portals and clearinghouses
• EMR and document management systems
• 835/837 files and EFT/ERA reconciliation tools

Success Metrics

• Maintain a clean claim rate of 95% or higher.
• Reduce DSO month over month according to RCM leadership targets.
• Meet first-pass payment rate and denial overturn rate goals.
• Submit final claims within 48 hours of billable readiness.

Benefits

• Health,
• Dental,
• Vision
• Life Insurance
• 401k + Company match
• Paid holidays
• PTO package
• Paid orientation
• Employee Referral Program

EQUAL EMPLOYMENT OPPORTUNITY

We are an equal opportunity employer. We do not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, genetic information, or any other protected characteristic under federal, state, or local law. Reasonable accommodation is available per ADA and applicable state laws.

Pay: $25.00 to $29.00 Hourly