HMO Billing Specialist

Job Title: Medicare Billing Specialist – Skilled Nursing
Location: Smithtown, NY
Job Type: Full-Time, Direct Hire
Salary: $78,000–$80,000 per year, depending on experience
Schedule: Monday–Friday, On-Site

Job Overview

We are seeking an experienced Medicare / HMO Billing Specialist to join a well-established healthcare organization in Smithtown, NY.

The ideal candidate will have prior Medicare billing experience within a skilled nursing facility, nursing home, or long-term care environment. This role will focus on Medicare, HMO, and MLTC billing, claims follow-up, and ensuring timely and accurate reimbursement.

Candidates with strong Medicare billing experience who are comfortable learning a new billing system are encouraged to apply.

Responsibilities

• Handle Medicare, HMO, and MLTC billing and claims.
• Submit and follow up on claims for timely reimbursement.
• Research and resolve denied, rejected, and unpaid claims.
• Review outstanding accounts and payment discrepancies.
• Follow up with insurance carriers regarding claim status.
• Maintain accurate billing documentation and account records.
• Monitor accounts receivable and outstanding balances.
• Work closely with the Accounts Receivable and billing teams.
• Ensure billing is completed accurately and in accordance with payer requirements.
• Assist with billing responsibilities across multiple locations as needed.

Qualifications

• Previous Medicare billing experience required.
• Skilled nursing, nursing home, or long-term care billing experience strongly preferred.
• Experience with HMO and/or MLTC billing preferred.
• Strong understanding of healthcare claims, denials, reimbursement, and accounts receivable.
• Experience using healthcare billing systems and payer portals.
• Avalon experience is a plus, but not required.
• Strong attention to detail and organizational skills.
• Ability to independently manage a high volume of claims.
• Strong communication and problem-solving skills.

If you have Medicare billing experience within a skilled nursing or long-term care setting and are looking for your next opportunity in Smithtown, NY, we encourage you to apply.