Impress employers and recruiters.
Choose from hundreds of resume examples.

Impress employers and recruiters.
Choose from hundreds of resume examples.

Target Resume Now

About the Role

Serves as a subject matter expert for Skilled Nursing Facility (SNF) reimbursement, responsible for accurate and timely billing, collections, account reconciliation, denial management, and payment posting for various payers. Collaborates with multiple teams to maximize reimbursement, resolve issues, and ensure compliance.

Responsibilities

• Prepares and submits timely clean claims to various insurance companies electronically or by paper.
• Responsible for co-insurance and/or co-pay billing to residents and/or responsible parties.
• Ensures claims are submitted timely and comply with payer-specific requirements.
• Reviews census, payer, and reimbursement information for accuracy prior to claim submission.
• Monitors claim status and proactively resolves billing edits, rejections, denials, and underpayments.
• Manages appeals and reconsiderations for denied or disputed claims.
• Utilizes accounts receivable aging reports to identify and resolve outstanding balances.
• Follows up with insurance carriers and managed care organizations regarding unpaid claims and reimbursement issues.
• Investigates payment variances and coordinates corrective actions.
• Collaborates with Admissions, MDS, Rehabilitation, Clinical Operations, and Finance teams to ensure accurate reimbursement.
• Maintains current knowledge of CMS regulations, Medicare Advantage requirements, payer guidelines, and reimbursement changes.
• Assists in month-end accounts receivable reconciliation and reporting.
• Identifies opportunities to improve billing processes, reduce denials, and strengthen cash collections.
• Serves as a resource to other billing team members regarding Medicare and Managed Care billing requirements.
• Participates in audits, regulatory reviews, and special projects as assigned.
• Performs other duties as assigned in support of St. John's mission, vision, and values.

Requirements

• 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.
• 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 collections.
• Experience 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.
• 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.
• Visual acuity required to review billing records, insurance documentation, and computer screens.
• Ability to communicate effectively with residents, families, staff, and third-party payers.

Skills

• Medicare Part A billing
• Medicare Advantage billing
• Managed Care billing
• Third-party payer billing
• Denial management
• Appeals
• Collections
• Accounts receivable follow-up
• Microsoft Excel
• Microsoft Word
• Microsoft Outlook
• Billing systems
• PointClickCare (desirable)
• Analytical skills
• Organizational skills
• Problem-solving skills
• Verbal communication skills
• Written communication skills
• SNF reimbursement methodologies
• Regulatory requirements
• Payer contracts
• Authorizations
• Claims edits
• Reimbursement rules
• Aging reports analysis
• Claim denials management
• Audits
• Payer correspondence management

Location

• Office environment within a healthcare setting

Work Type

• Full-time

Experience Level

• Senior
• Minimum 5 years healthcare billing experience
• Minimum 3 years SNF/LTC billing experience

Education Level

• High school diploma or equivalent
• Associate degree preferred

About the Company

• St. John’s mission, vision, values and Brand Characteristics.
• Brand Characteristics - 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, 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.