Medicaid Billing Specialist - Skilled Nursing Facilility

Position Summary

The Medicaid Billing Specialist supports the nursing home residents and their representatives through the financial aspects of skilled nursing care, with primary responsibility for Medicaid eligibility, applications, renewals, billing coordination, and account follow-up. This role serves as a primary point of contact for residents, family members, responsible parties, community partners, and internal departments; explains financial obligations clearly; gathers and verifies required documentation; and helps ensure accurate, timely reimbursement in accordance with facility policies and applicable requirements.

Essential Duties and Responsibilities

Serve as the primary financial Medicaid contact for residents, family members, responsible parties, referral partners, and other authorized representatives. Interview residents or representatives to evaluate payer sources, financial resources, and potential Medicaid eligibility. Explain Medicaid application requirements, resident liability, patient-pay amounts, spend-down obligations, covered services, and other financial responsibilities in clear, respectful language.

Prepare, submit, and track Medicaid applications, redeterminations, renewals, conversions, and changes in eligibility status. Collect, review, and organize financial, identity, residency, income, asset, insurance, and authorization documents required to support eligibility and billing for Medicaid. Follow up with residents, representatives, case workers, eligibility offices, insurers, and other parties to resolve missing information or application delays.

Monitor pending Medicaid accounts and maintain accurate status notes, deadlines, correspondence, approvals, denials, and appeal documentation. Coordinate with admissions, social services, nursing, business office, therapy, and billing teams to support accurate payer setup and uninterrupted claims processing. Review account balances, remittances, denials, eligibility dates, authorizations, and payer changes; escalate discrepancies and support timely corrections or rebilling.

Weekly Medicaid billing and posting, resident statements, collections follow-up, and account reconciliation as assigned. Identify potential coverage gaps and help develop timely resolution plans. Protect resident confidentiality and handle financial and health information in accordance with privacy, security, and facility requirements.

Participate in audits, account reviews, and month-end activities. Perform other related duties as assigned.