Managed Care Billing Specialist*

Jewish Home Lifecare - New York, NY

Full-time - Mid Level

New York, NY

Nursing and Residential Care Facilities

About the position

The Managed Care Billing Specialist at The New Jewish Home is responsible for resolving denied and underpaid managed care claims efficiently. This role requires a deep understanding of managed care contracts and the ability to communicate effectively with various stakeholders to ensure timely resolution of claim disputes. The specialist will collaborate with managed care organizations (MCOs) and utilize billing systems to track performance and identify discrepancies in payments.

Responsibilities

• Understand managed care contracts and create project spreadsheets for submission to payers.
• Write reconsideration appeals and send them to MCOs.
• Communicate internally and externally for resolution of claim disputes.
• Collaborate with all MCO payers to resolve payment errors and underpayments.
• Submit monthly excel reports and written appeals letters to resolve external underpayments in a timely fashion.
• Track MCO responses.
• Utilize billing system (Netsmart/MyUnity) to identify payment discrepancies and monitor performance of recoveries.
• Work closely with Revenue Cycle Director to resolve issues as they arise.
• Perform other duties as assigned by the Director of Revenue Cycle.

Requirements

• Minimum 5 years' experience in health insurance, skilled nursing home billing.
• Understanding of Medicare, Managed Care, Medicaid (NY) billing and reimbursement.
• Prior experience with managed care claims and appeals processes for skilled nursing homes.
• Fluency in working with billing systems.
• Understanding of EOBs and remittance advice.
• Full understanding of managed care contracts and payment methodologies.
• Strong skills with Excel, Patient Accounting systems, and Provider Portals.
• Strong communication skills and ability to de-escalate conversations.
• Ability to work independently and meet deadlines.
• Detail-oriented with strong critical thinking and organization skills.

Nice-to-haves

• Experience writing board minutes.
• Keyboard skill of 50 - 55 WPM.