Medical Billing & Reimbursement Specialist
Reports to: Controller
Status: Non-Exempt, hourly
About the role
The Medical Billing & Reimbursement Specialist manages billing and reimbursement activity related to healthcare services provided within Waterman Village. This role helps ensure that claims are submitted accurately, payments are posted correctly, denials are addressed promptly, and reimbursement requirements are met. The work requires both technical precision and steady follow-through. You will work with clinical, admissions, resident financial services, and accounting colleagues to support appropriate reimbursement while helping residents and families navigate financial questions with respect.
What you will own
- Claims preparation and submission. Prepare, review, and submit claims to Medicare, Medicaid, managed care plans, commercial insurers, the VA, and other applicable payers.
- Charge and documentation review. Confirm that charges, authorizations, eligibility information, coding, and supporting documentation are complete before submission.
- Payment posting and reconciliation. Post payer payments, contractual adjustments, denials, and other account activity accurately; reconcile remittances to claims and resident accounts.
- Denial management. Research denials, correct claim errors, prepare appeals or reconsiderations when appropriate, and track resolution through final payment or documented closure.
- Payer follow-up. Follow up with payers on unpaid, underpaid, delayed, or disputed claims in a timely and professional manner.
- Reimbursement compliance. Stay current on payer requirements, billing deadlines, coverage rules, and documentation standards that affect reimbursement.
- Aging and collection support. Review assigned accounts receivable aging, prioritize follow-up, and escalate complex reimbursement issues when needed.
- Reporting and audit support. Prepare billing, collection, denial, and reimbursement reports; maintain documentation needed for audits, cost reports, and regulatory review.
- Collaboration and process improvement. Partner with clinical teams, admissions, resident financial services, and accounting to reduce claim errors, improve documentation, and strengthen revenue-cycle performance.
- Other duties as assigned. Perform additional duties and special projects assigned by the Controller.
What you will bring
- High school diploma or equivalent required; associate degree, medical billing certification, or relevant coursework is preferred.
- Three to five years of medical billing, reimbursement, claims, or healthcare accounts receivable experience.
- Working knowledge of Medicare, Medicaid, managed care, private-pay, and other payer processes relevant to senior living, home health, or long-term care.
- Experience with claims submission, remittance advice review, denial management, and payer follow-up.
- Relevant certification, such as Certified Professional Biller or equivalent, is preferred but not required.
Skills that matter here
Medical billing and claims software proficiency; strong knowledge of payer portals and electronic claims processes; Excel skills; accuracy; follow-through; discretion; clear communication; problem-solving; and the ability to manage deadlines and changing payer requirements.
Equal Employment Opportunity, Workplace Expectations, and Acknowledgment
Waterman Communities, Inc. is an Equal Opportunity Employer. Employment decisions are made without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, genetic information, marital status, veteran or military status, or any other characteristic protected by applicable law. Waterman Communities, Inc. is committed to a workplace free from discrimination and harassment and provides reasonable accommodations to qualified individuals with disabilities and for sincerely held religious beliefs, consistent with applicable law. Employment with Waterman Communities, Inc. is at will. These descriptions summarize the essential expectations of each role and are not intended to create an employment contract or an exhaustive list of all duties. Responsibilities may be modified as organizational needs change.
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