Managed Care & Medicare Billing Specialist

Cantex-Continuing-Care-Network; Carrollton (TX); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Competitive pay

Bonus opportunities

Health, dental, vision insurance

Supplemental benefits

401(k) with company match

Generous PTO/Sick time

Career growth opportunities

Supportive company culture

Other employee perks

Job summary

Cantex-Continuing-Care-Network is seeking a Managed Care / Medicare Billing Specialist to oversee accounts receivable, billing, claims processing, collections, and reimbursement for multiple Skilled Nursing Facilities in Texas. This role focuses on accurate, timely submission and compliant revenue cycle management.

You will verify eligibility, post payments, resolve denials, and collaborate with providers, payers, and internal teams to maintain healthy cash flow and aging metrics.

Qualifications

• High school diploma required; college degree or equivalent advanced coursework preferred.
• Prior managed care and Medicare billing experience in a Skilled Nursing Facility (SNF) environment required.
• Strong knowledge of healthcare billing software, including American HealthTech (AHT) and/or HealthMEDX Vision preferred.
• Understanding of Medicare Part A billing, managed care billing, reimbursement methodologies, and long-term care revenue cycle operations.
• Knowledge of ICD-9 and ICD-10 diagnosis coding principles.
• Ability to prioritize workload, manage multiple deadlines, and work efficiently in a fast-paced environment.
• Strong analytical, organizational, customer service, and communication skills.
• Team-oriented mindset with willingness to support other areas of medical billing and accounts receivable.

Responsibilities

• Process monthly managed care and Medicare Part A claims for multiple Skilled Nursing Facilities.
• Create, submit, track, and reconcile managed care and Medicare claims.
• Analyze, research, and resolve denied, rejected, or underpaid claims.
• Verify Medicare eligibility, benefit periods, skilled coverage days, and payer requirements.
• Post payments and ensure accurate reimbursement reporting.
• Communicate with providers, facilities, payers, and internal stakeholders regarding billing questions and claim status.
• Ensure all billing is accurate, complete, and compliant with federal, state, Medicare, Medicaid, and payer regulations.
• Coordinate third‑party billing activities with facility personnel and operational teams.
• Collaborate with fiscal intermediaries, auditors, cost report preparers, state agencies, federal agencies, and commercial insurance carriers.
• Monitor accounts receivable balances and maintain aging within established company goals.
• Assist with collection efforts and resolution of complex reimbursement issues.
• Utilize billing software to improve workflow efficiency, claim accuracy, and revenue cycle performance.
• Understand payer transmission requirements and ensure proper electronic claim submission.
• Analyze and resolve technical billing issues involving claims processing, resident accounts, reimbursement calculations, and claim transmission errors.
• Maintain compliance with all billing regulations, revenue cycle initiatives, and company financial management systems.
• Prepare and distribute billing, reimbursement, collection, and accounts receivable reports as requested.
• Support company DSO, cash collection, and reimbursement goals through proactive account management.
• Perform additional duties and special projects as assigned by the AR Manager, Director of Finance, or CFO.

Skills

Managed care billing

Medicare billing

ICD-9/ICD-10 knowledge

Analytical skills

Organizational skills

Communication skills

Team-oriented

Education

High school diploma

College degree preferred

Tools

American HealthTech (AHT)

HealthMEDX Vision

Job description

Cantex-Continuing-Care-Network is seeking a Managed Care / Medicare Billing Specialist to oversee accounts receivable, billing, claims processing, collections, and reimbursement for multiple Skilled Nursing Facilities in Texas. This role focuses on accurate, timely submission and compliant revenue cycle management.

You will verify eligibility, post payments, resolve denials, and collaborate with providers, payers, and internal teams to maintain healthy cash flow and aging metrics.