Lead Medicaid Billing & Revenue Recovery Specialist - Skilled Nursing & Assisted Living Job Overview We are a growing healthcare revenue recovery company specializing in helping Skilled Nursing Facilities (SNFs) and Assisted Living (AL) facilities identify and recover revenue that has already been earned but remains outstanding. We are seeking a highly experienced Lead Medicaid Billing & Revenue Recovery Specialist with extensive knowledge of New York SNF and Assisted Living Medicaid billing and accounts receivable . This is not a traditional medical billing position focused solely on submitting current claims. The primary focus of this role is aged accounts receivable and revenue recovery —reviewing outstanding Medicaid and managed care balances, determining why claims have not been paid, resolving complex billing issues, and aggressively following accounts through to payment. The ideal candidate has significant hands-on experience within the skilled nursing and/or assisted living industry and is comfortable independently reviewing large aging reports, identifying collectible balances, correcting billing issues, navigating payer requirements, and recovering revenue from claims that may be months or even years old. As the company grows, this individual will also have the opportunity to play an important role in developing billing processes, establishing best practices, and assisting with the training and oversight of additional billing professionals. Duties Review SNF and Assisted Living aging reports and identify outstanding Medicaid and managed care balances with recovery potential. Research aged and unresolved accounts to determine the underlying reason claims remain unpaid. Work accounts from initial investigation through final resolution and payment. Correct and resubmit rejected, denied, or improperly billed Medicaid claims. Follow up directly with Medicaid, managed care plans, HMOs, facilities, and other appropriate parties to resolve outstanding receivables. Investigate eligibility, authorization, coverage, rate, enrollment, billing, and claim-processing issues affecting reimbursement. Work complex Medicaid-pending and eligibility-related accounts when applicable. Identify billing opportunities or missed revenue that may have previously been overlooked, underpaid, or written off. Navigate New York Medicaid systems, payer portals, billing platforms, EMR/EHR systems, and facility records as necessary to resolve accounts. Maintain clear documentation regarding account status, actions taken, outstanding issues, and recovered revenue. Prioritize accounts based on collectability, dollar value, account age, filing limitations, and other relevant factors. Communicate with facility administrators, business offices, finance teams, and other stakeholders when information or documentation is required. Provide regular reporting regarding accounts being worked, barriers to collection, recoveries, and overall progress. Help develop efficient internal billing and revenue-recovery procedures as the company grows. Assist with training and mentoring additional billing staff as the billing operation expands. Required Experience & Qualifications Significant New York Skilled Nursing Facility and/or Assisted Living Medicaid billing experience is required. Strong hands-on experience working Medicaid accounts receivable and aging. Demonstrated experience resolving difficult, denied, rejected, or significantly aged Medicaid accounts. Strong knowledge of New York Medicaid billing requirements and reimbursement processes. Experience with Medicaid managed care and other Medicaid-related payer plans. Ability to independently analyze an aging report and determine the appropriate recovery strategy for individual accounts. Experience researching eligibility, authorization, enrollment, rate, billing, and payer-related reimbursement issues. Strong understanding of SNF and/or Assisted Living business-office and revenue-cycle operations. Comfortable working with billing software, payer portals, EMR/EHR systems, spreadsheets, and electronic records. Excellent organizational skills and attention to detail. Strong written and verbal communication skills. Ability to work independently, manage a substantial caseload, and take ownership of accounts through resolution. Preferred Qualifications Experience managing billing or accounts receivable across multiple SNFs and/or Assisted Living facilities. Experience recovering substantial aged Medicaid receivables. Experience handling accounts more than 12 months old. Experience with Medicaid-pending residents and complex eligibility issues. Previous leadership, supervisory, or lead billing experience. Experience developing billing workflows or training other Medicaid billing professionals. Who We Are Looking For We are looking for someone who understands that successful revenue recovery requires much more than simply submitting a claim. The right candidate knows how to look at an unpaid balance, investigate what happened, identify what needs to be corrected, determine who needs to be contacted, and continue working the account until every reasonable avenue for reimbursement has been exhausted. If you have spent years working New York SNF and/or Assisted Living Medicaid accounts and know how to recover money from difficult or aged receivables, we would like to speak with you. This is an opportunity to join a growing specialized revenue recovery operation and become a key part of building and expanding its billing division.

Pay:

$75,000.00 - $125,000.00 per year

Work Location:

Hybrid remote in South Hempstead, NY 11581