Role Description
The Medicaid Accounts Receivable Specialist ensures accurate, timely billing and reimbursement - both general AR and Medicaid-specific - for residents across the portfolio. This role serves as the go-to expert on Medicaid processes while handling day-to-day AR duties, partnering closely with community business office staff and leadership to maintain compliance, protect revenue, and deliver excellent customer service.
Essential Job Functions
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Accounts Receivable
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Maintain daily communication with Business Office Managers (BOMs) and Executive Directors to resolve AR needs and account inquiries, providing timely, professional service (including across shared email inboxes).
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Manage the monthly billing and month-end cycle: process AR forms, verify deposits, run and validate billing, and process resident settlements.
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Review aging reports and occupancy activity to identify and resolve outstanding account issues.
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Enter payment reports, returned payments, and related adjustments; process ACH payments, resident refunds, and referral payments per company policy.
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Collaborate with community leadership and internal departments to maintain AR compliance and account accuracy.
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Medicaid Billing & Reimbursement
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Support Medicaid authorization intake, verification, and documentation (electronic and community historical files); verify and enter Medicaid rates with Business Office Directors.
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Manage monthly Medicaid billing, including standardized adjustment and LOA credit methodology, and coordinate claims filing after month-end (e.g., via Sunbound), cross-checked against leaves of absence.
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Post Medicaid payments from remittance advices to the correct month of service, track overpayments as credits, and retain remittance documentation.
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Research and resolve Medicaid account discrepancies and denials, including full account audits when payments don't match billed totals; track denials, appeals, and adjustments.
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Lead scheduled Medicaid account audits (e.g., quarterly) and monitor aging of Medicaid balances over 90 days, escalating as needed.
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Verify resident Medicaid eligibility and ensure compliance with Medicaid regulations, coding guidelines, and state-specific payer requirements across all applicable states.
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Prepare reports on Medicaid reimbursement trends, denials, aging, and payment performance for leadership.
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Deliver onboarding and ongoing training to BOMs and EDs on AR and Medicaid processes, systems, and best practices.
Qualifications
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Strong knowledge of Medicaid regulations, billing, and reimbursement processes; multi-state experience a plus.
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Experience with Medicaid/healthcare billing systems and claims software; knowledge of basic accounting.
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Proficiency in MS Office (Excel, Word, Outlook).
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Strong interpersonal, oral, and written communication skills - regularly liaises with BOMs, EDs, and state agencies.
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Excellent attention to detail, analytical, and organizational skills.
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Self-directed, results-oriented, and able to work well under pressure to meet deadlines.
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Sound judgment, integrity, and a proactive, energetic approach to new challenges.