Remote Medical Claims Examiner Jobs in Rochester, NY

Description

 Angels In Your Home, a licensed home care services agency serving individuals across New York State, is seeking a detail-oriented and reliable Billing Specialist / Home Care Biller to join our administrative team.

This is a full-time position responsible for supporting accurate and timely billing, claims submission, payment follow-up, and account reconciliation for home care services. The Billing Specialist / Home Care Biller will work collaboratively with internal departments, payers, managed care plans, insurance representatives, and other stakeholders to ensure billing processes are completed accurately, efficiently, and in accordance with payer requirements and agency procedures.

Primary responsibilities include:

• Prepare, review, and submit billing claims for home care services in accordance with payer requirements, agency procedures, and applicable regulations.
• Ensure billing information is accurate, complete, and supported by appropriate documentation prior to submission.
• Review authorizations, service records, schedules, timesheets, EVV data, and related documentation to support accurate billing.
• Post payments, adjustments, denials, and other account activity accurately and timely.
• Reconcile billed services, payments received, outstanding balances, and payer remittance information.
• Identify billing discrepancies and work with appropriate internal staff to resolve issues.
• Monitor aging accounts and follow up on unpaid or denied claims.
• Communicate with payers, managed care plans, insurance representatives, and other parties regarding claim status, payment issues, and billing corrections.
• Assist with resolving claim denials, rejections, underpayments, and outstanding balances.
• Maintain accurate billing records and documentation in accordance with agency policy, payer requirements, and applicable regulatory standards.
• Protect confidential client and agency information in compliance with HIPAA and agency privacy practices.
• Stay informed of billing requirements, payer updates, and process changes that may impact claims submission or reimbursement.
• Work closely with scheduling, intake, payroll, compliance, and clinical staff to address billing-related questions or documentation needs.
• Communicate clearly and professionally regarding billing issues, missing information, authorizations, and claim corrections.

Requirements

• Prior experience in healthcare billing, home care billing, Medicaid Managed Care billing, or medical claims processing preferred.
• Experience with LHCSA, home care, or long-term care billing is strongly preferred.
• Knowledge of Medicaid, managed care plans, authorizations, EVV, and payer billing requirements preferred.
• Experience with HHAeXchange, eMedNY, managed care portals, or similar billing systems preferred.
• Strong attention to detail and ability to identify discrepancies in documentation, schedules, authorizations, and claims.
• Ability to manage multiple priorities, meet deadlines, and maintain organized records.
• Strong written and verbal communication skills.
• Proficiency with Microsoft Office, especially Excel and Outlook.
• High school diploma or equivalent required.
• Associate degree or additional healthcare billing training preferred.

Angels In Your Home is an Equal Opportunity Employer and does not discriminate based on race, color, religion, sex, age, national origin, disability, veteran status, or any other protected status under federal, state, or local law.