Resident Billing and Waiver Specialist

Join our team at Great Lakes Management as our Resident Billing & Waiver Specialist! This position is responsible for managing and maintaining Elderly Waiver claim processing while ensuring accurate and timely billing operations. The ideal candidate will have strong organizational skills, attention to detail, the ability to navigate multiple systems and technology platforms, and the ability to effectively manage competing priorities in a fast-paced environment. This position is based in-office at our corporate office in Plymouth, with potential for hybrid work arrangement in the future.

Job Details:

• Hours: Part-time, 25 – 29 hours per week with potential opportunity for full-time employment in the future
• Pay: $25 – $30 / hour
• Location: 12755 Hwy 55 Ste J-125, Plymouth, MN 55441

Responsibilities:

• Submit monthly Elderly Waiver (EW) claims accurately and timely
• Maintain billing accuracy related to service dates, rates, and resident obligations
• Update billing systems to reflect changes in authorizations, daily rates, spenddowns, and resident liabilities
• Partner with community teams to support smooth resident transitions to Elderly Waiver programs and ensure timely communication with residents/families
• Monitor service authorizations proactively to prevent lapses in billing and reimbursement
• Coordinate with case managers, counties, and community teams to obtain updated authorizations prior to expiration
• Manage MCO (Managed Care Organization) claims and payment follow-up to maximize reimbursement and resolve outstanding balances
• Post and reconcile payments within the billing system
• Communicate with providers, payors, and vendors regarding claims, authorizations, and payment discrepancies
• Assist with autopay and electronic payment setup with applicable vendors/payors
• Review accounts receivable aging reports and investigate denied, unpaid, or underpaid claims
• Maintain compliance with Medicaid and Elderly Waiver billing regulations and company policies
• Support ongoing process improvement initiatives related to billing accuracy and reimbursement workflows

Qualifications:

• Associate’s or Bachelor’s degree in Healthcare Administration, Accounting, Business, or related field preferred
• Minimum of 2 years of Medicaid, healthcare, or long-term care billing experience preferred
• Experience with Elderly Waiver (EW) billing processes strongly preferred
• Strong attention to detail with the ability to maintain a high level of accuracy in a fast-paced environment
• Proficient computer and software skills; experience with Eldermark/X12 and Waystar preferred
• Strong organizational, communication, and problem-solving skills
• Ability to work independently while also collaborating effectively with corporate and community teams
• Knowledge of healthcare reimbursement, claims processing, and accounts receivable management preferred