Billing Specialist

EXEMPT:  No                                                                     SHIFT:  8.0-hour work day - M-F

DEPARTMENT: Finance                                                    LOCATION:  Main Office

REPORTS TO: Accounting Manager                               

Summary

The Billing Specialist, under the supervision of the Accounting Manager, is responsible for ensuring accurate and timely billing and collections for all Private Pay, Medicaid, and other third-party payers. This position plays a critical role in maintaining Pine Castle’s financial sustainability by ensuring compliance with state and federal billing regulations, resolving billing discrepancies, and supporting staff and participants with clear communication.

The Billing Specialist models Pine Castle’s Core Values by embracing differences, respecting personal choice, caring deeply, and practicing servant leadership in all billing interactions.

Essential Duties and Responsibilities

The following duties are representative of the role. Other duties may be assigned as necessary.

Billing & Invoicing

• Process monthly billing for Medicaid (Med Waiver), APD, CDC, and Private Pay participants/residents.
• Create and distribute monthly invoices for Private Pay and Social Security accounts as necessary.
• Ensure all service authorizations are received, accurate, and current before billing.

Collections & Customer Support

• Coordinate with Program Directors to facilitate timely collection of outstanding receivables.
• Respond to billing inquiries from participants, caregivers, program staff, and auditors with professionalism and clarity.
• Conduct timely research and correction of denied claims, including submission of appeal and replacement claims when necessary.
• Establish and maintain communication with internal staff and external payers to resolve billing issues and secure timely, accurate, and maximum reimbursement.
• Maintain strong working relationships across programs, operations, and finance to resolve billing issues promptly.

Compliance & Recordkeeping

• Maintain accurate billing records, authorization forms, reports, and supporting files in compliance with state, federal, and HIPAA requirements.
• Provide monthly itemization of all past due accounts, and recommended adjustments to the Accounting Manager.
• Uphold strict confidentiality and adhere to HIPAA guidelines at all times.

Reporting & Special Projects

• Prepare and update spreadsheets for billing reconciliations, analysis, and reporting.
• Assist with audits, special projects, and cross-departmental initiatives as needed.
• Actively participate in department meetings and continuing education to enhance billing knowledge.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience

• Minimum of three (3) years of professional billing, coding, and reimbursement experience, preferably in a community healthcare or nonprofit setting.
• Experience with Microsoft Windows, Excel, and billing software or websites such as Availity, OPTUM Pay, and ICANotes.
• Priority will be given to candidates with experience in mental health billing and Medicaid HCBS Waiver program billing.

Knowledge of:

• Medicaid and private billing requirements.
• State and federal billing regulations, including coding and reimbursement standards.

Certificates, Licenses, Registrations

• Must maintain required certifications and trainings, including HIPAA, Direct Care Core Competencies, Zero Tolerance, CPR, and First Aid, as directed by Pine Castle’s organizational policies.

Other Skills and Abilities

• Strong Excel and data management skills.
• Excellent written and verbal communication skills.
• Strong time management and prioritization abilities.
• Ability to work independently with minimal supervision.
• Analytical skills to interpret data, recognize discrepancies, and recommend solutions.
• Demonstrates integrity, confidentiality, and accountability in all work.

Physical Demands

• Regularly required to sit, talk, and hear.
• Frequently required to use hands to handle or feel objects, tools, or controls.
• Occasionally required to walk, reach, or lift to 10 pounds.
• Vision requirements include close and distance vision and the ability to adjust focus.

Work Environment

• Standard office environment.
• Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

Salary : $23