Billing Specialist

Title: Billing Specialist

Department: Finance

Reports To: Revenue Cycle Manager

FLSA Status: Full-time/Non-Exempt

Company Overview

At CGA Holdings (CGA/Ready Care), our referred in-home caregivers provide a range of services aimed at ensuring the comfort, safety and compassionate care of a family’s loved ones. Homecare isn’t just tailored for aging seniors seeking care in the comfort of their homes; it’s also a valuable option for those recuperating from surgery, living with special needs, or managing chronic conditions. In-home caregivers can offer both short-term and long-term services, guaranteeing a family’s loved one’s comfort and well-being in the familiar surroundings of their own home, whether their needs call for support over a few months or several years.

Our administrative team plays a significant role in supporting our clients and caregivers. Compassionate Expertise is a team commitment with a dedication to delighting every client and to delivering services at the highest level of excellence possible. This position is critical to the growth goals of CGA and our commitment to delighting clients every day.

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Position Summary

Reporting to the Revenue Cycle Manager, the Billing Specialist supports the daily operations of the revenue cycle for the registry division, ensuring accurate billing, payment processing, and account management. This role contributes to efficient service delivery and client satisfaction by maintaining billing accuracy, resolving discrepancies, and supporting timely collections. The Billing Specialist follows established processes and best practices to ensure compliance with Florida regulations and internal policies, while collaborating with internal teams to promote operational efficiency and a positive client experience.

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Key Responsibilities

• Billing and Insurance Process
• Establish payer profiles for new clients based on Verification of Benefits (VOB) or private pay arrangements.
• Accurately input all payer information into the system, including payer name, contact details, and policy numbers.
• Verify completeness and accuracy of all payer data prior to billing.
• Set up required authorizations and/or assign secondary payer status as appropriate to prevent unbilled claims.
• Review billing drafts to ensure accuracy of reported hours and services provided; coordinate with caregivers as needed for clarification.
• Generate and validate invoices, confirming correct billing codes, payer information, and applicable rates.
• Ensure accurate application of billing rates for both Long-Term Care (LTC) and private pay services.
• Payment Process
• Accurately post client and insurance payments, including deposits and checks, into the Matri system.
• Review accounts to identify missed invoices and initiate appropriate follow-up actions.
• Conduct account audits to detect overpayments and coordinate refund processing when applicable.
• Process and reconcile ACH and credit card transactions, ensuring accurate application to the appropriate client accounts.
• Prepare and distribute draft aide payroll reports for review and approval.
• Finalize payroll reports and provide completed versions to Administrative and Scheduling teams.
• Complete payroll processing and upload required extract files to Paychex.
• Review and process off-cycle or missed payroll runs, ensuring accuracy of amounts and timeliness of payments.
• Communicate with the Finance team regarding any additional payroll processing requirements.
• Client Refund and Adjustments
• Review and assess client accounts to determine eligibility for refunds, including overpayments and billing discrepancies.
• Process client refunds in accordance with company policies, ensuring all required documentation is accurate and properly maintained.
• Execute invoice adjustments, including write-offs and charge transfers, with appropriate supporting documentation.
• Prepare and submit refund worksheets to the accounting team, ensuring completeness and accuracy of all related records.
• Weekly and Monthly Reporting
• Perform monthly close activities within the Matrix system, including reconciliation of unbilled revenue and resolution of any discrepancies.
• Proactively communicate with clients to address and resolve billing and payment inquiries in a timely and professional manner.
• Compile and submit all required documentation for the annual audit, ensuring accuracy, completeness, and adherence to deadlines.
• Prepare and deliver annual payment reports to clients upon request, ensuring all information is accurate and well-documented.
• Miscellaneous Tasks and Support
• Establish and maintain organized Accounts Receivable (AR) folders for daily and monthly deposits, ensuring all records are accurate, complete, and audit-ready.
• Maintain and manage 1099 documentation folders in compliance with reporting requirements and company standards.
• Upload client and caregiver invoices to OL Connect for electronic delivery and portal distribution to Long-Term Care (LTC) payers and private pay clients.
• Monitor and resolve issues related to unmatched or rejected invoices, collaborating with supervisory staff to ensure timely resolution.

Perform other duties and responsibilities as assigned

Qualifications

Education & Experience:

• Bachelor’s degree in Business, Finance, or related field (Master’s preferred).
• 2 years of progressive leadership experience in billing, preferably in registry or home health.
• Working knowledge of health care billing and compliance processes
• Demonstrated ability to support client retention by ensuring accurate billing, timely issue resolution, and a high level of customer service
• Exceptional leadership, communication, and strategic thinking skills.

Skills & Competencies:

• Excellent leadership, communication, and negotiation skills
• Strategic thinking and execution skills
• Excellent computer skills, proficient with Microsoft office
• Creative problem-solving skills, organized and detail oriented
• Flexible and able to multi-task, time management skills
• Team player, positive attitude, proactive and consistent follow through
• Capable of working independently and exercising discretion and independent judgment

Work Environment

• Leadership meeting participation and leading staff meetings are essential for collaboration across all departments
• Positivity and a commitment to operational excellence, and a willingness to work cross-functionally is critical to ensure each client experiences “best in home care services” each day
• This position is designated as an in-person role

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EEO Statement

CGA is an Equal Opportunity Employer and Registry. We comply with all applicable federal, state, and local laws prohibiting discrimination in employment. We do not discriminate based on race, color, religion, sex (including pregnancy, sexual orientation, or gender identity), national origin, age, disability, genetic information, marital status, veteran status, or any other protected characteristic under applicable law. Employment decisions are based on qualifications, merit, and business needs.