Find Jobs
Find Jobs Near You – Available Work in Your Location
Sr. Billing Specialist
Career Insights for Billing Specialist (General)
See where this job fits in the broader career landscape. Knowing your career path helps you see what's possible from here.
Scorecard
Based on New Jersey data
Review key factors to help you decide if this role fits your goals. How is this calculated?
What they do
A Billing Specialist performs administrative work at financial institutions and banks that handle bills, receipts, and invoices. Manages the status of client accounts and tracks financial records, charges, and receipts of the accounts.
$48,401 / year median in New Jersey
+1% projected growth
Job Description
Heart to Heart is seeking a highly organized, detail-oriented and experienced Billing Specialist to join our Revenue Cycle Team. This position is responsible for the timely, accurate and compliant billing of Medicaid waiver services for individuals receiving Intellectual and Developmental Disabilities (IDD) services in New Jersey )Division of Developmental Disabilities - DDD) and Pennsylvania (Office of Developmental Programs - ODP). The ideal candidate will possess strong knowledge of Medicaid billing regulations, revenue cycle processes and electronic billing systems. Experience with Therap, PROMISe and HCSIS is highly preferred. The successful candidate will be responsible for ensuring clean claims, minimizing denials, maximizing reimbursement and supporting the financial health of the organization. Required Qualifications High School Diploma or equivalent required; Associate's or Bachelors degree preferred Minimum of two (2) years of medical billing, Medicaid billing or Revenue Cycle Management experience Strong understanding of claims processing, payment posting, accounts receivable and denial management Excellent organizational and analytical skills Strong written and verbal communication abilities High level of attention to detail and accuracy Ability to prioritize multiple deadlines in a fast paced environment Proficiency is Microsoft Office, particularly Excel Preferred Qualifications Experience billing New Jersey Division of Developmental Disabilities (DDD) services Experience billing Pennsylvania Office of Developmental Programs (ODP) services Experience using Therap for service documentation, billing validation and provider workflows Experience using PROMISe for Pennsylvania Medicaid billing, claim inquiry, payment reconciliation and remittance review Experience navigating HCSIS (Home and Community Services Information System) to review authorizations, service plans, provider information and waiver services Knowledge of Electronic Visit Verification (EVV) requirements Experience billing residential, community-based, day habilitation, behavioral support, employment, respite and other waiver-funded IDD services Technical Skills Therap PROMISe HCSIS Electronic Visit Verification (EVV) platforms Medicaid billing software Electronic Health Record (EHR) systems Clearinghouse claim submission portals Microsoft Excel (including filtering, pivot tables and reconciliation functions) Essential Duties and Responsibilities Billing & Claims Management Prepare, review, and submit Medicaid waiver claims accurately and on time. Process billing for New Jersey DDD and Pennsylvania ODP services Review service documentation to ensure all billing requirements have been met prior to claim submission Verify authorizations and billing eligibility before claims are submitted Ensure compliance with Medicaid regulations, payer requirements, and agency policies. Monitor claim edits and resolve billing exceptions before submission Submit corrected claims and rebill services as necessary. Accounts Receivable Management Monitor outstanding claims and accounts receivable. Investigate denied, rejected, unpaid, or partially paid claims. Research billing discrepancies and coordinate timely resolutions. Prepare appeals and supporting documentation when appropriate. Maintain accurate documentation of billing activities and follow-up efforts. Payment Posting & Reconciliation Post electronic remittance advice (ERA) and manual payments. Reconcile payments against submitted claims. Identify underpayments, overpayments, and payment variances. Assist with monthly reconciliation and revenue reporting. Work collaboratively with Finance to ensure billing accuracy. Documentation & Compliance Ensure billing documentation supports all submitted claims. Maintain compliance with Medicaid, HIPAA, and state regulations. Stay informed of changes to New Jersey DDD and Pennsylvania ODP billing requirements. Assist with internal and external audits. Collaboration Work closely with Clinical, Program Operations, Scheduling, Payroll, Human Resources, and Finance departments. Communicate with state agencies, managed care organizations, and payers regarding billing issues. Participate in process improvement initiatives to improve billing accuracy and efficiency. Provide excellent customer service to internal departments regarding billing inquiries.