Resident Benefits and Billing Specialist

Responsible for managing Medicaid application processes, coordinating outpatient therapy billing, and scheduling resident appointments and transportation. Serves as a liaison between residents, families, healthcare providers, community agencies, and facility departments to support timely financial eligibility processing, accurate billing practices, and efficient coordination of resident services.

Major responsibilities

• Assist residents and responsible parties with Medicaid application and redetermination processes.
• Gather, review, and organize financial and supporting documentation.
• Monitor application status and follow up with residents, families, state agencies, and eligibility specialists.
• Track pending Medicaid applications and maintain accurate records.
• Communicate status updates to facility leadership and business office personnel.
• Ensure compliance with state and federal Medicaid regulations and reporting requirements.
• Assist with resident trust fund and financial inquiries.
• Process and monitor outpatient therapy billing documentation.
• Verify insurance coverage and benefits for outpatient therapy services.
• Coordinate with therapy providers to ensure complete and accurate billing records.
• Submit and reconcile outpatient therapy charges.
• Review billing reports for accuracy and address discrepancies.
• Maintain organized records to support audits and reimbursement requirements.
• Communicate with residents, families, insurers, and therapy vendors regarding billing issues.
• Schedule and coordinate resident medical, dental, vision, dialysis, specialty care, and other healthcare appointments.
• Arrange transportation for resident appointments using facility vehicles, contracted transportation services, or community resources.
• Maintain appointment calendars and transportation logs.
• Notify nursing staff, residents, families, and transportation providers of appointment details and changes.
• Ensure required documentation accompanies residents to appointments.
• Track appointment outcomes and obtain follow-up documentation as needed.
• Maintain confidential resident records in accordance with HIPAA regulations.
• Prepare reports, spreadsheets, and correspondence as requested.
• Assist with resident admission and discharge-related administrative tasks.
• Serve as a resource for residents and families regarding financial and appointment coordination matters.
• Participate in interdisciplinary meetings as appropriate.
• Perform other duties as assigned by the Administrator or Business Office Manager.