Sr. Billing Specialist

St Johns Health Care Corporation; City of Rochester (NY); On-site; USD 65,000 - 85,000; Full time

Job summary

St Johns Health Care Corporation seeks a Senior Billing Specialist to join the Finance team and manage submissions, follow up on rejections, and post payments for Medicare and other third-party payers. You will collaborate with a cross-functional team to ensure timely and accurate reimbursement.

The role emphasizes strong analytical skills, attention to payer rules, and compassionate communication with residents and families regarding insurance obligations.

Qualifications

• High school diploma or equivalent required; Associate degree preferred.
• Minimum five (5) years of healthcare billing experience required.
• Minimum three (3) years of SNF/LTC billing experience required.
• Expertise in Medicare Part A, Medicare Advantage, Managed Care and third-party payer billing.
• Experience with denial management, appeals, collections, and AR follow-up.
• Experience communicating with residents, families, and responsible parties about insurance benefits and billing inquiries.

Responsibilities

• Prepare and submit clean claims to various insurance companies electronically or by paper.
• Bill co-insurance and/or co-pay amounts to residents and/or responsible parties.
• Ensure timely submission of claims and compliance with payer requirements.
• Review census, payer, and reimbursement information for accuracy before submission.
• Monitor claim status and resolve edits, rejections, denials, and underpayments.
• Manage appeals and reconsiderations for denied or disputed claims.
• Use AR aging reports to identify and resolve outstanding balances.
• Follow up with insurance carriers and managed care organizations regarding unpaid claims.
• Investigate payment variances and coordinate corrective actions.
• Collaborate with Admissions, MDS, Rehabilitation, Clinical Operations, and Finance to ensure accurate reimbursement.
• Maintain knowledge of CMS regulations, Medicare Advantage requirements, payer guidelines, and reimbursement changes.

Skills

Healthcare billing expertise

Medicare Part A & Advantage

Denial management

Accounts receivable follow-up

Communication with residents/families

Analytical skills

Organizational skills

Independent work

Education

High school diploma or equivalent

Associate degree preferred

Tools

Microsoft Excel

Microsoft Word

Microsoft Outlook

PointClickCare

Billing systems

Job description

Description

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 collectionsExperience 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.

Requirements

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.