Utilization and Billing Specialist

Metro Homes, Inc; Washington (District of Columbia); On-site; USD 55,000 - 60,000; Full time

Benefits offered by this job

Dental insurance

Health insurance

Life insurance

Retirement plan

Vision insurance

Job summary

Metro Homes, Inc is seeking a Utilization and Billing Specialist to manage utilization review, recertification, licensure, and contract renewals, and to oversee the full billing and accounts receivable cycle across program lines.

The role serves as liaison between program directors, clinical staff, and external funding and regulatory agencies to ensure timely, accurate service authorizations and compliant billing.

Qualifications

• Bachelor’s degree in Business Administration, Healthcare Administration, Finance, or a related field preferred.
• Experience in medical, behavioral health, or human services billing, accounts receivable, or utilization review.
• Proficiency with QuickBooks and Microsoft Excel; experience with Quickbase, IMANAGE, MCIS or similar portals is a plus.
• Strong written and verbal communication skills; ability to coordinate across departments and agencies.
• Exceptional organizational skills with the ability to manage multiple billing cycles and deadlines.

Responsibilities

• Manage full-cycle billing across program lines including multiple waivers and services.
• Verify service authorizations against services rendered and ensure billing falls within authorized time frames.
• Prepare, generate, and submit invoices through portals and systems; manage billing logs.
• Coordinate admission/discharge processes and track renewals and licensure.

Skills

Billing proficiency

Accounts receivable

Utilization review

Communication skills

Organizational skills

Confidentiality

Education

Bachelor's degree in Business Administration, Healthcare Administration, Finance, or related field

Tools

QuickBooks

Microsoft Excel

Quickbase

IMANAGE

MCIS

Job description

Utilization and Billing Specialist Position Summary

The Utilization and Billing Specialist is responsible for managing the utilization review, recertification, licensure, and contract renewal functions that support program revenue and regulatory compliance, and full billing and accounts receivable cycle across the organization's program lines.This role serves as the primary point of coordination between program directors, clinical staff, and external funding and regulatory agencies (including DHCF, DDS, DDS, DDS, DOH, and HSCSN) to ensure timely, accurate uninterrupted service authorization for the individuals served and billing.

Essential Duties and Responsibilities

Utilization Review & Revenue Management

• Track and process Long-Term Care (LTC) recertifications (Form 1445), requesting the Level of Need (LON) from the Director of Nursing 60-70 days in advance and completing/submitting applications through Quickbase.
• Track and process DOH Certificate of Licensure renewals, ensuring applications are completed and submitted at least 90 days in advance of expiration.
• Review and ensure Business License is updated and renewed
• Track and submit lease renewals to DDS and prepare and submit the annual Human Care budget to DDS.
• Track and submit Maximus new enrollments and re-enrollments.
• Keep track of Acuity Expirations for all ICF clients
• Keep track of Medicaid eligibility for all ICF/DDS clients
• Audit client funds and generate Over Resource reports to maintain compliance with benefit eligibility requirements.
• Track and facilitate contract renewals across programs, including ICF, DDS Waiver, and other as needed.
• Support and document admission and discharge processes across ICF, DDS, and Day Program lines.

Billing & Accounts Receivable

• Manage full-cycle billing across program lines, including ICF, Waiver, Day Program, HSCSN, Human Care, Consultant, and PT (Personal Therapy/provider) billing.
• Request and review monthly and weekly census data by program; confirm billable days, new admissions, home visits, and hospital stay prior to billing.
• Maintain organized census and billing documentation in Therap & IMANAGE and other recordkeeping systems.
• Verify service authorizations against services rendered to confirm accuracy and ensure billing falls within authorized time frames; communicate authorization discrepancies to Program Directors.
• Prepare, generate, and submit invoices through applicable systems and portals (E-Invoicing, ICF/WAIVER portal, vendor portals, and other web-based billing portals); mail or transmit invoices to providers as required.
• Receive and process consultant invoices in coordination with Accounts Payable; track consultant hours and maintain accurate billing logs.

General & Administrative

• Serve as a liaison between program staff, clinical leadership, and external funding/regulatory agencies to resolve billing, authorization, and compliance issues.
• Maintain up-to-date knowledge of program-specific billing, licensure, and regulatory requirements.
• Prepare reports and documentation for internal leadership and external audits as requested.
• Perform other duties as assigned.

Qualifications

• Bachelor's degree in Business Administration, Healthcare Administration, Finance, or a related field preferred; an equivalent combination of education and relevant experience will be considered.
• Experience in medical, behavioral health, or human services billing, accounts receivable, or utilization review, ideally within an IDD (intellectual/developmental disabilities), behavioral health, or child welfare services setting.
• Working knowledge of program billing, authorization, and licensure requirements for agencies such as DBH, DDS, CFSA, HSCSN, and DOH strongly preferred.
• Proficiency with QuickBooks and Microsoft Excel required; experience with Quickbase, IMANAGE, MCIS, or similar billing/case management portals is a plus.
• Understanding of service authorization, LTC recertification, and facility licensure renewal processes.
• Exceptional organizational skills and attention to detail, with the ability to manage multiple concurrent billing cycles, renewal deadlines, and reporting requirements.
• Strong written and verbal communication skills, with the ability to coordinate effectively across internal departments and external regulatory/funding agencies.
• Ability to work independently, prioritize competing deadlines, and maintain strict confidentiality of sensitive client and financial information.

Pay:$55,000.00 - $60,000.00 per year

Benefits:

• Dental insurance
• Health insurance
• Life insurance
• Retirement plan
• Vision insurance

Education: Bachelor's (Preferred)

Work Location:In person.