Senior Billing Specialist

Required Qualifications High School Diploma or equivalent required; Associate's or Bachelors degree preferredMinimum of two (2) years of medical billing, Medicaid billing or Revenue Cycle Management experienceStrong understanding of claims processing, payment posting, accounts receivable and denial managementExcellent organizational and analytical skillsStrong written and verbal communication abilitiesHigh level of attention to detail and accuracyAbility to prioritize multiple deadlines in a fast paced environmentProficiency is Microsoft Office, particularly Excel Preferred Qualifications Experience billing New Jersey Division of Developmental Disabilities (DDD) servicesExperience billing Pennsylvania Office of Developmental Programs (ODP) servicesExperience using Therap for service documentation, billing validation and provider workflowsExperience using PROMISe for Pennsylvania Medicaid billing, claim inquiry, payment reconciliation and remittance reviewExperience navigating HCSIS (Home and Community Services Information System) to review authorizations, service plans, provider information and waiver servicesKnowledge of Electronic Visit Verification (EVV) requirementsExperience billing residential, community-based, day habilitation, behavioral support, employment, respite and other waiver-funded IDD services Technical Skills TherapPROMISeHCSISElectronic Visit Verification (EVV) platformsMedicaid billing softwareElectronic Health Record (EHR) systemsClearinghouse claim submission portalsMicrosoft 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. 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).

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 preferredMinimum of two (2) years of medical billing, Medicaid billing or Revenue Cycle Management experienceStrong understanding of claims processing, payment posting, accounts receivable and denial managementExcellent organizational and analytical skillsStrong written and verbal communication abilitiesHigh level of attention to detail and accuracyAbility to prioritize multiple deadlines in a fast paced environmentProficiency is Microsoft Office, particularly Excel Preferred Qualifications Experience billing New Jersey Division of Developmental Disabilities (DDD) servicesExperience billing Pennsylvania Office of Developmental Programs (ODP) servicesExperience using Therap for service documentation, billing validation and provider workflowsExperience using PROMISe for Pennsylvania Medicaid billing, claim inquiry, payment reconciliation and remittance reviewExperience navigating HCSIS (Home and Community Services Information System) to review authorizations, service plans, provider information and waiver servicesKnowledge of Electronic Visit Verification (EVV) requirementsExperience billing residential, community-based, day habilitation, behavioral support, employment, respite and other waiver-funded IDD services Technical Skills TherapPROMISeHCSISElectronic Visit Verification (EVV) platformsMedicaid billing softwareElectronic Health Record (EHR) systemsClearinghouse claim submission portalsMicrosoft 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 andsupportingdocumentation 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.