Billing​/Claims Specialist

Location:

Brooklyn, NY

Salary: $52K-$80K

The Billing and Claims Specialist is responsible for managing all aspects of billing, claims submission, and reimbursement for a home care agency serving patients under MLTC (Managed Long Term Care) plans and other insurance providers. This role ensures accurate and timely billing, compliance with payer requirements, and effective follow-up on claims to maximize reimbursement and minimize denials.

• Prepare, submit, and track claims for MLTC plans, Medicaid, Medicare (if applicable), and commercial insurance
• Review authorizations, service hours, and eligibility prior to billing
• Ensure accurate coding and claim data in accordance with payer guidelines
• Process electronic and paper claims as required by payers

• Monitor claim status and follow up on unpaid, denied, or underpaid claims
• Investigate and resolve billing discrepancies and denials
• Submit corrected or resubmitted claims as needed
• Post payments, adjustments, and denials accurately into billing systems
• Reconcile remittance advice (EOBs/ERAs) with billed claims

• Track MLTC authorizations, service limits, and expiration dates
• Ensure billing aligns with approved care plans and service authorizations
• Maintain compliance with Medicaid, MLTC, and insurance regulations
• Stay current on payer rule changes and billing requirements

• Minimum 2–3 years of billing and claims experience in home care, healthcare, or related setting
• Hands‑on experience with MLTC billing and insurance claims
• Strong knowledge of Medicaid and managed care billing processes
• Proficiency with home care billing software and clearinghouses
• Excellent attention to detail and organizational skills