Skilled Nursing Facility, Assisted Living, and Independent Living Billing Specialist

Job Description

The Billing Specialist is responsible for accurate, timely billing and accounts receivable follow-up for skilled nursing facility, assisted living, and independent living services. This position manages resident billing, Medicare, Medicaid, managed care, private pay, and other payer accounts while supporting compliance with applicable billing regulations, payer requirements, and facility policies.

Essential Duties and Responsibilities

• Prepare, submit, and monitor billing for skilled nursing, assisted living, private pay, Medicare, Medicaid, managed care, hospice, coinsurance, and secondary payer accounts.
• Review census data, payer changes, authorizations, rates, ancillary charges, and resident account information to ensure claims and statements are accurate.
• Post payments, adjustments, electronic remittance advices, refunds, and other account activity in a timely and accurate manner.
• Follow up on unpaid claims, denials, rejections, underpayments, and aging balances to support timely reimbursement.
• Communicate professionally with residents, responsible parties, families, insurance representatives, case managers, state agencies, and facility staff regarding billing questions and account status.
• Assist residents and responsible parties with Medicaid eligibility, spend-down tracking, payer changes, and required financial documentation.
• Maintain accurate resident financial files, billing records, supporting documentation, and confidentiality of all resident and facility information.
• Participate in month-end close, accounts receivable review, triple-check processes, audits, cost reports, and special accounting or billing projects as assigned.
• Monitor changes in payer requirements, reimbursement rules, and long-term care billing practices to help ensure compliance.
• Collaborate with admissions, nursing, social services, therapy, business office, and administrative teams to resolve billing discrepancies and improve revenue cycle processes.

Required Qualifications

• High school diploma or equivalent required; associate degree in accounting, business administration, healthcare administration, or related field preferred.
• Prior experience in medical billing, healthcare accounts receivable, long-term care billing, or general accounting preferred.
• Working knowledge of Medicare, Medicaid, managed care, private pay, coinsurance, and long-term care billing processes preferred.
• Experience with electronic billing systems, resident accounting software, electronic remittance processing, and Microsoft Office applications, especially Excel.
• Ability to maintain confidentiality and comply with HIPAA, payer requirements, company policies, and applicable healthcare billing regulations.

Knowledge, Skills, and Abilities

• Strong attention to detail, accuracy, and follow-through.
• Excellent written and verbal communication skills, including the ability to explain billing matters clearly and respectfully.
• Ability to organize priorities, meet deadlines, and manage multiple payer types and billing cycles.
• Analytical and problem-solving skills to research account discrepancies, denials, and reimbursement issues.
• Professional demeanor when working with residents, families, coworkers, vendors, and payer representatives.
• Ability to work independently while also contributing effectively to a team-based care and business office environment.

Physical and Work Environment Requirements

This position is typically performed in an office setting within a healthcare or long-term care environment. The role requires regular computer use, telephone communication, sitting for extended periods, handling confidential information, and occasional interaction with residents, families, and facility staff. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.