Senior Billing Specialist

Minimum Starting Salary: $61,494

BENEFITS: Project HOME offers a competitive compensation package which includes health, prescription, dental, and vision coverage at minimum cost to our employees, company-funded life and disability insurances, paid parental leave, spending accounts, and a 401K plan with 100% matching contributions up to 5% of compensation. Additionally, we offer generous PTO accruals, which include paid sabbatical leave.


Job Summary: The Senior Billing Specialist supports the revenue cycle operations of Project HOME Health Services (PHHS) by overseeing complex medical billing functions, ensuring accurate and timely credentialing of all providers, managing claim submission and denials, and helping to optimize reimbursement across all payers and lines of business. This role serves as a subject matter expert for billing workflows and supports compliance with federal and state billing regulations.

Essential Duties and Responsibilities

Routine Billing Responsibilities:

• Verify coding accuracy using ICD-10, CPT, and HCPCS standards prior to claims submission and/or during the rejection and denial processes
• Prepare and submit clean claims to all payers including Medicaid, Medicare, Medicare Advantage, MCOs, and Commercial payers using the EMR
• Review, research, and correct denied or rejected claims; perform rebilling and ensure timely resolution
• Continuously monitor claim statuses and queues notifying the Revenue Manager of potential issues and recommend EMR system updates
• Perform payment posting and reconciliation functions in conjunction with the other billing staff
• Recommend write-offs to Revenue Manager

Credentialing & Payer Enrollment:

• Manage credentialing and re-credentialing for all providers across medical, mental health, and dental disciplines, including monitoring expiration dates to prevent lapses
• Support Revenue Manager and Sr. Director of Operations in the preparation, submission, and tracking of payer enrollment and re-credentialing applications
• Compile and maintain complete, current, and accurate provider documentation including licenses, DEA registrations, board certifications, malpractice coverage, and other required credentials in partnership with the Compliance & Risk Management Specialist and HR
• Maintain insurance company provider rosters and perform primary source verification, as required
• Maintain provider data in credentialing databases such as CAQH, PECOS, and NPPES

Administration:

• Manage staff user access to payer portals
• Provide claim data tracking, trending, & reporting to the Revenue Manager as requested
• Assist in gathering requested supporting documentation for the annual audit, annual Medicare Cost Report, and tri-annual HRSA audits
• Collaborate with the Revenue Manager and across departments to identify and address root causes of denials, rejections, and bad debt
• Serve as a Subject Matter Expert (SME) for billing and front desk staff, providing guidance, support, and onboarding as requested
• Maintain knowledge of payer regulations, FQHC reimbursement rules, and changes to Medicaid/Medicare policies impacting billing
• Ensure patient confidentiality and billing security protocols in compliance with HIPAA
• Assist in documentation of internal workflows and policies and procedures as requested
• Additional duties as assigned by the Revenue Manager

Minimum Qualifications:

• Associate's degree in Medical Billing and Coding or High school diploma/GED with 3 years equivalent experience in health care billing.
• At least three (3) years experience in health care billing, with strong working knowledge of Medicare and Medicaid billing requirements
• At least two (2) years experience with eClinicalWorks (eCW) or two (2) years experience on a billing team at an FQHC with an Electronic Health Records (EHR)/Practice Management (PM) System
• Provider credentialing experience
• Proficiency with Electronic Health Records (EHR)/Practice Management (PM) Systems, with preference for experience working in work queues, reviewing charges, resolving denials, and payment posting
• Attention to detail
• Intermediate Microsoft Excel experience, including general navigation, reading/interpreting data, and using charts and pivot tables

What Qualifications or Experience You May Bring:

• Credentialling in an FQHC setting
• Experience with dental billing
• Hold current medical billing and coding certification from the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA)
• Advanced knowledge of Pennsylvania Medicaid Managed Care Organizations (MCOs) billing requirements
• Strong knowledge of Federally Qualified Health Center (FQHC) revenue cycle management processes
• Advanced Excel skills and strong proficiency in other Microsoft Office applications

PHYSICAL REQUIREMENTS

Ability to move to or remain sedentary for periods of time in various locations

Project HOME provides equal employment opportunities to all employees and applicants for employment, without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability status, protected veteran status, genetic information, or any other characteristic protected by federal, state, or local laws. Project HOME prohibits discrimination and harassment of any type.

Project HOME reserves the right to revise or change job duties and responsibilities as needed. This job description is not meant to be an all-inclusive statement of the duties and responsibilities of the job, nor does it constitute a written or implied contract.