Job Description

Experience the Positive, Innovative, and Flexible Culture at Pathway Health Services!

At Pathway Health Services, we believe in working hard and having fun. Our positive culture fosters an environment where innovation thrives, and we empower our team to think outside the box and develop creative solutions to challenges. With flexibility at the core of what we do, we adapt to change seamlessly by delivering the best possible service to our clients.

The Billing Specialist is responsible for assigned client projects that may include revenue cycle operations for skilled nursing facilities, assisted living communities, and hospice centers. This role ensures accurate billing, timely collections, and compliance with Medicare, Medicaid, private insurance, and private-pay regulations to support organizational financial performance and cash flow.

Responsibilities:

• Prepare, review, and submit accurate primary and secondary claims for Medicare, Medicaid, HMO, long-term care insurance, and private-pay accounts.
• Utilize billing software and clearinghouse systems to ensure timely claim submission and follow-up.
• Verify patient insurance eligibility and benefits prior to and during a resident's stay.
• Identify authorization requirements and ensure all necessary documentation is obtained.
• Post insurance and resident payments accurately within billing systems.
• Reconcile remittances, account balances, and ledgers to ensure financial accuracy.
• Monitor and resolve payment discrepancies.
• Investigate denied or rejected claims and determine appropriate corrective actions.
• Collaborate with Business Office Managers (BOMs), insurance carriers, and internal departments to resolve billing issues promptly.
• Resubmit corrected claims within payer deadlines.
• Maintain accurate admission, discharge, transfer, and leave-of-absence records.
• Update resident demographic and insurance information within EMR and billing systems.
• Ensure billing records remain current and compliant.
• Review Accounts Receivable (A/R) aging reports and identify delinquent accounts.
• Initiate collection activities and respond to resident and family billing inquiries professionally and efficiently.
• Assist with month-end reporting and cash collections activities as needed.
• Other responsibilities as assigned.

Qualifications:

• High school diploma or equivalent required.
• Associate or bachelor's degree in business administration, Healthcare Administration, Accounting, or related field preferred.
• Minimum of 1-3 years of healthcare billing experience preferred.
• Prior experience within long-term care, skilled nursing, assisted living, or senior housing environments strongly preferred.
• Proficiency with medical billing software, EMR systems, and clearinghouse portals.
• Strong Microsoft Excel and general computer skills.
• Familiarity with Medicare, Medicaid, managed care, and private insurance billing processes.
• Understanding of HIPAA privacy standards and healthcare billing regulations.
• Knowledge of long-term care reimbursement guidelines and payer requirements.
• Exceptional attention to detail and accuracy.
• Strong organizational and multitasking abilities.
• Excellent communication and customer service skills.
• Ability to manage deadlines in a fast-paced environment.
• Problem-solving skills with the ability to independently resolve billing issues.

Special Position Requirements:

• Must maintain all required professional licenses and certifications if applicable.
• Provide proof of current and in good standing licensure if applicable.
• Must maintain active driver's license and provide proof of auto insurance upon request.
• Travel may be required.

Physical Demands:

• Ability to endure prolonged walking, sitting, standing, use of pulling bending and stooping movements.
• Ability to talk and hear.
• Dexterity of hands and fingers to operate a computer keyboard and mouse.
• Must be able to lift and/or move up to 25 pounds.
• Ability to endure the physical demands of traveling. (i.e. air travel and auto travel).

Mental Demands:

• Must be able to demonstrate emotional stability.
• Must be able to work under pressure to maintain organizational goals.
• Must be able to demonstrate ability to work well with others.
• Ability to adapt to changes in daily work hours and schedule.

Eligible employees may enjoy a comprehensive benefits package that can include:

• 401(k) Retirement Plan- Plan for your future with company-supported contributions.
• Paid Time Off- Vacation and sick leave to recharge and handle personal matters.
• Medical Premium Reimbursement- Support for health insurance costs.
• Dental Coverage - Optional dental plans to keep your smile healthy.
• Ancillary Benefits - Additional products and perks, such as vision coverage, life insurance, and wellness programs.

Pathway Health is an independently owned, nationally recognized consulting company that provides expert services to long-term healthcare, senior housing, assisted living, home care, and hospice organizations.

Join us at Pathway Health and experience a workplace that values your unique contributions and supports your growth.

Pathway Health is an EEO/AAP Employer.

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