Medicare Programs Billing Specialist
Role Overview
The Medicare Programs Billing Specialist is a key member of the Finance Department responsible for overseeing and managing billing activities related to Medicare payer lines.
The primary responsibility of this position is to independently manage and submit PACE (Program of All-Inclusive Care for the Elderly) billing for specified locations, with responsibility expected to grow as additional offices and programs are added.
The position will ensure PACE billing is accurate, timely, compliant, and properly reconciled.
For Medicare GUIDE (Guiding an Improved Dementia Experience), the Billing Specialist will provide financial oversight and monitoring of billing activity performed by designated staff, ensuring billing is complete, accurate, and appropriately reflected in financial records.
The Specialist will identify discrepancies, monitor outstanding items, and work with the appropriate staff to resolve issues.
This position requires strong attention to detail, knowledge of billing processes, financial reconciliation skills, and the ability to manage increasing billing volume as the organization grows.
Full Job Posting
PACE Billing
Own and manage the complete PACE billing process.
Prepare, review, and submit PACE claims and billing on a timely basis.
Ensure all billable services are supported by appropriate documentation and meet applicable billing requirements.
Monitor PACE billing for accuracy, completeness, and compliance.
Track submitted claims, payments, denials, rejections, adjustments, and outstanding balances.
Research and resolve billing discrepancies and rejected or denied claims.
Reconcile PACE billing activity to payments and financial records.
Maintain accurate billing records and supporting documentation.
GUIDE Billing Oversight
Provide financial oversight of GUIDE billing activities performed by designated billing staff.
Monitor GUIDE billing to ensure claims and invoices are submitted timely and accurately.
Review billing reports and financial activity for unusual trends, discrepancies, or missing information.
Monitor outstanding GUIDE claims and receivables.
Assist billing staff with escalated billing questions or issues.
Ensure GUIDE billing activity is properly reconciled and reflected in Finance records.
Communicate recurring billing issues or concerns to Finance leadership and appropriate operational staff.
Help establish and maintain consistent billing controls and processes.
Qualifications and Skills
High school diploma or equivalent required; associate or bachelor’s degree in accounting, finance, business, or related field preferred.
2+ years of experience in medical, healthcare, human services, or other third-party billing.
Experience with accounts receivable, claims processing, payment posting, and reconciliation.
Strong attention to detail and ability to identify discrepancies.
Strong organizational skills and ability to manage multiple locations and competing deadlines.
Proficiency with Microsoft Excel and other Microsoft Office applications.
Ability to work independently while collaborating effectively with operational and Finance teams.
Ability to maintain confidentiality and handle sensitive financial and participant information.
Requirements
- High school diploma or equivalent required; associate or bachelor’s degree in accounting, finance, business, or related field preferred.
- 2+ years of experience in medical, healthcare, human services, or other third-party billing.
- Experience with accounts receivable, claims processing, payment posting, and reconciliation.
- Strong attention to detail and ability to identify discrepancies.
- Strong organizational skills and ability to manage multiple locations and competing deadlines.
- Proficiency with Microsoft Excel and other Microsoft Office applications.
- Ability to work independently while collaborating effectively with operational and Finance teams.
- Ability to maintain confidentiality and handle sensitive financial and participant information.
About Cornerstone Caregiving
Private in-home senior care provider serving seniors and their caregivers across the United States.
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