Nursing Care Billing Specialist

About the Role:
We are seeking a detail-oriented Nursing Care Billing Specialist to manage end-to-end resident billing and accounts receivable functions for our on-site skilled nursing facility. This role covers Medicare, Medicaid (Medical Assistance), Medicare Advantage/Managed Care, commercial insurance, Long-Term Care insurance, and private pay. You will use MatrixCare as the primary electronic health record (EHR) and billing platform, ensuring accurate claim submission, timely collections, regulatory compliance, and seamless coordination with clinical, admissions, and finance teams.

Key Responsibilities:

Revenue Cycle & Claims Management

• Prepare, submit, and monitor skilled nursing home claims for:
• Medicare Part A and Part B
• Medicare Advantage (MA) / Managed Care Organizations (MCOs)
• Medicaid (Medical Assistance)
• Commercial and supplemental insurance
• Long-Term Care insurance
• Private pay residents
• Generate, review, and submit claims using MatrixCare billing and financial modules, clearinghouses, and payer portals in compliance with CMS and payer-specific requirements.
• Validate resident, payer, and charge data within MatrixCare prior to claim submission to ensure billing accuracy and compliance.
• Track claim status, resolve rejections and denials, submit corrected claims, and complete appeals with appropriate clinical and financial documentation.
• Ensure accurate coordination of benefits (COB) and secondary payer billing within MatrixCare and payer systems.

Admissions, Eligibility & Authorizations

• Review admissions, discharges, payer changes, and level-of-care/status changes daily using MatrixCare census and payer reports.
• Verify Medicare Part A skilled coverage eligibility, available benefit days, and benefit exhaustion dates at admission and throughout the stay.
• Obtain, document, and maintain all required prior authorizations, continued stay reviews, and eligibility verifications for Medicare Advantage, Medicaid, and managed care plans.
• Enter benefit, authorization, and coverage notes into MatrixCare for interdisciplinary visibility.
• Participate in interdisciplinary admissions, Medicare, and managed care meetings to remain current on resident coverage and care status.
• Maintain and distribute accurate daily census and payer mix reports to internal departments and contracted service providers as required.

Medicaid (Medical Assistance) Billing & Compliance

• Prepare and submit Medicaid (Medical Assistance) claims and supporting documentation in accordance with federal and state regulations.
• Maintain organized and current Medicaid eligibility records, including benefit cards, authorization notices, and required forms, with appropriate tracking in MatrixCare.
• Notify the County Assistance Office (CAO) or applicable agency of income, asset, or status changes impacting eligibility.
• Monitor pending Medicaid applications and communicate status updates to admissions, social services, and finance teams.
• Prepare for and support Medicaid utilization reviews, eligibility audits, and third-party oversight (e.g., UMR), ensuring MatrixCare records and supporting documentation are complete and audit-ready.

Private Pay & Resident Financial Accounts

• Generate and distribute private pay statements from MatrixCare in accordance with established billing cycles and timelines.
• Respond professionally and promptly to billing inquiries from residents and responsible parties.
• Process refunds, adjustments, and rate changes accurately within MatrixCare.
• Manage resident trust/personal allowance accounts when acting as representative payee, including required reporting for Social Security and Railroad Retirement benefits.

Cash Posting, Reconciliation & Reporting

• Post and reconcile cash receipts, electronic remittance advices (ERAs), and explanation of benefits (EOBs) to resident accounts in MatrixCare.
• Reconcile payer remittances, billing logs, and CMS reports (including PS&R) to ensure accuracy and identify discrepancies.
• Prepare and submit required regulatory reports, including the Medicare Credit Balance Report.
• Maintain accurate accounts receivable aging and supporting documentation using MatrixCare reporting tools.

Collections & Write-Offs

• Monitor outstanding balances using MatrixCare aging and AR reports and initiate follow-up actions in accordance with organizational collection policies.
• Communicate unresolved balances, financial risks, and recommended actions to the CFO or Finance leadership.
• Coordinate with CFO and legal counsel when necessary and maintain documentation for approved write-offs in accordance with internal controls and regulatory timelines.

Accounts Payable & Ancillary Coordination

• Review and approve resident-related ancillary invoices (pharmacy, therapy, labs, insurance premiums, physician services) for accounts payable processing when permitted.
• Reconcile therapy and ancillary billing with departmental and MatrixCare records prior to approval.

Compliance, Training & Cross-Coverage

• Remain current on CMS guidance, Medicaid bulletins, managed care requirements, and MatrixCare system updates affecting billing and reimbursement.
• Participate in ongoing education and training related to billing, compliance, reimbursement changes, and MatrixCare functionality.
• Maintain strict confidentiality and comply with HIPAA and organizational privacy standards.
• Cross-train and provide coverage for other billing functions as needed.

Qualifications

• High school diploma or equivalent required; associate degree in business, accounting, or healthcare administration preferred.
• Minimum five years of experience in healthcare billing, including Medicare, Medicaid, and managed care.
• Experience with MatrixCare or comparable SNF EHR/billing systems strongly preferred.
• Working knowledge of CMS billing rules, PDPM, managed care authorization processes, and coordination of benefits.
• Strong analytical, organizational, and communication skills.
• Ability to work independently, manage competing priorities, and meet regulatory deadlines.
• Experience with Microsoft Office Suite.

Pay: $25.00 per hour

Benefits:

• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Referral program
• Vision insurance

Work Location: In person