Long-Term Care Medical Biller

Job Description

Job DescriptionLong-Term Care Medical Biller

About Garden Spot Communities

Garden Spot Communities has evolved into a community that thrives on purpose, opportunity and living life to its fullest. While others in our market space talk about seniors and retirement, here we talk about people and opportunity. Our heritage, mission and core values play a fundamental role as they ground us in the present and shape our future.

Discover Garden Spot’s benefits and how you can experience Life with Purpose™

• Health insurance
• 401K program with company match
• Tuition assistance
• First-time home-buyer program
• $20/hr

Overview

Garden Spot Village is seeking a detail-oriented Long-Term Care Medical Biller to assist in the completion of the billing cycle for our long-term care facilities. This role is responsible for ancillaries, claims submission, payment posting, trust accounts, account reconciliation, and diligent follow-up on unpaid claims to ensure timely and accurate reimbursement for long-term care services.

Essential Functions

• Account Receivables and Collections:
• Monitor and manage the entire revenue cycle, ensuring timely processing and follow up with insurance carriers on unpaid or denied claims, and resolve discrepancies, disputes, or issues.
• Process payments, reconcile accounts; apply adjustments, write-offs, and refunds when necessary
• Billing & Coding Compliance:
• Ensure proper coding of services using ICD-10, CPT, and HCPCS codes to maximize reimbursement and minimize denials.
• Apply appropriate modifiers, diagnoses, and procedures for all claims.
• Stay updated on changes in billing regulations, coding updates, and insurance company guidelines.
• Maintain compliance with federal and state regulations, including HIPAA.
• Claim Processing & Submission:
• Review and verify patient demographic and insurance information before billing to prevent errors and claim rejections.
• Enter and post monthly ancillaries.
• Prepare, review, accurately process, and submit institutional claims (UB-04) for long-term care services, including skilled nursing, rehabilitation, and other related services in a timely fashion for Medicaid, Medicare, Advantage Plans ensuring timely filing, compliance with payer guidelines and contractual obligations.
• Collaboration & Support:
• Collaborate with admissions, billing, clinical and administrative teams to ensure proper documentation and coding of services provided.
• Provide support during internal audits, assist with documentation requests, and assist in reconciling discrepancies in revenue reporting.
• Customer Service:
• Respond to inquiries from residents, families, and insurance providers regarding billing and payment issues.
• Provide clear, timely, and professional communication with residents regarding their billing inquiries and balances.

• Documentation & Record-Keeping:

• Maintain detailed and accurate records of all billing activities and communication with insurance providers and patients.
• Meet monthly with supervisor for A/R review

Qualifications

• Education & Experience:
• High school diploma or equivalent required (Associate’s or bachelor’s preferred).
• Skills & Knowledge:
• Excellent analytical and organizational skills.
• Strong communication skills, both written and verbal, to work effectively with residents, insurance carriers, and healthcare teams.

Personal Attributes:

• Attention to detail: Strong attention to detail and organizational skills with the ability to handle high-volume billing processes
• Critical Problem-Solving & Independent Decision Making: Ability to troubleshoot billing issues and work through complex insurance claims and denials independently with minimal supervision while maintaining accuracy and efficiency.

• Time Management: Skilled at prioritizing tasks and meeting deadlines in a fast-paced environment.
• Team-Oriented: Collaborative and adaptable, with a willingness to assist colleagues and work as part of a team to achieve departmental goals.

Physical Requirements:

• Prolonged periods of sitting and working at a computer.
• Ability to lift up to 25 lbs. occasionally for office-related tasks.
• Able to perform repetitive tasks with attention to detail.

Equal Employment Opportunity

Garden Spot Communities is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all team members. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, or veteran status.