_Remote, full-time | 8:00 AM - 4:00 PM EST_
- Salary: $1,*****,400 USD/month_
- Experience with claims/billing in nursing homes required _
We are seeking an experienced **Claims Specialist** to manage insurance billing, follow-up, and revenue recovery for a **Skilled Nursing Facility (SNF)**.
This role is responsible for ensuring timely, accurate reimbursement from Medicare, Medicaid, and managed care payers by submitting clean claims, resolving denials, and aggressively following up on unpaid balances.
This is a **results-driven AR role**, not entry-level billing.
Claims Management
- Prepare, submit, and monitor **Medicare, Medicaid, and managed care claims**:
- Ensure claims comply with SNF-specific billing rules (PDPM, skilled days, benefit periods)
- Submit corrected claims as needed
Denials & Appeals
- Analyze claim denials and underpayments
- Identify root causes (authorization, eligibility, coding, timely filing, coverage)
- Prepare and submit **appeals with supporting documentation**:
- Track appeal deadlines and outcomes
AR Follow-Up
- Follow up on **aged and unpaid claims** via payer portals and phone calls
- Document all payer interactions clearly and accurately
- Escalate unresolved issues to supervisors when appropriate
Payment Posting & Reconciliation
- Review EOBs/ERAs for accuracy




- Identify short pays and request adjustments
- Reconcile payer balances against expected reimbursement
Cross-Functional Collaboration
- Work closely with billing, MDS, and clinical teams to resolve discrepancies
- Request and validate documentation needed to support claims and appeals
Compliance
- Maintain compliance with Medicare, Medicaid, and payer regulations
- Support audit requests and prevent recoupments through accurate billing
We need the following requirements:
- **2+ years of SNF or nursing home AR / claims experience (required)**:
- Strong knowledge of:
- Medicare Part A billing
- Medicaid billing processes
- Managed care authorizations
- PDPM reimbursement methodology
- Experience handling **denials and appeals** end-to-end
- Familiarity with SNF billing software and payer portals
- Strong attention to detail and documentation skills
- Excellent written and verbal communication skills
- Experience working AR follow-up queues with dollar targets
- Understanding of benefit days, skilled vs custodial care, and eligibility rules
- Prior experience reducing AR aging or denial rates
- Experience working remotely or in a high-volume billing environment
Pay: $20,****** - $24,****** per month
Work Location: Remote

📌 Biller/Claims Specialist (For U.S. Nursing Home) (Estado de México)
🏢 Remote Hive
📍 Estado de México