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A family-owned company, we have grown to become one of the nation’s largest providers of post-acute care, which includes skilled nursing rehabilitation centers, long-term care centers, assisted living communities, independent rehabilitation centers, and long-term acute care hospitals (LTACH). Our more than 150 skilled nursing, assisted living, independent living, behavioral health, and long-term care facilities deliver sophisticated and transformative care to nearly 16,000 residents and patients at any given time.

Since 1984, the CommuniCare Family of Companies has been committed to delivering exceptional person-centered care as a national leader in post-acute care for those that are chronically ill or have complex conditions. Our more than 150 skilled nursing, assisted living, independent living, behavioral health, and long-term care facilities deliver sophisticated and transformative care to nearly 16,000 residents and patients at any given time. CommuniCare employs more than 19,000 employees across six states (Ohio, Indiana, Maryland, Virginia, West Virginia, Pennsylvania). Due to continued growth, CommuniCare Health Services is currently recruiting for a Claims Validator / Biller to support our Central Billing Office team. PURPOSE/BELIEF STATEMENT The position of Managed Care Claims Validator / Biller is responsible for accurate and timely filing of all managed care claims on their assigned caseload with the appropriate insurance carrier. The position requires working with the CBO cash collections team, CBO cash posting team, Business Office Manager, Regional Director of Finance, MDS, Case Management, and others. The CBO claims validation staff will strive to always be the expert and resource to others for all aspects of the UB04 and 1500 claim forms. WHAT WE OFFER As a CommuniCare employee you will enjoy competitive wages and PTO plans. We offer full time employees a menu of benefit options from life and disability plans to medical, dental, and vision coverage from quality benefit carriers. We also offer 401(k) with employer match and Flexible Spending Accounts. JOB DUTIES/RESPONSIBILITIES Claim validators must be proficient with all coding required on claims for SNF billing. To ensure the highest possibility of billing a clean initial claim, the claim information requires validation against the data located within the PCC tabs and documents. The PCC data to validate on the claim may be contained within areas of the Census, AR Insurance, authorization documentation, and eligibility. The claims validator will play a role in triple check with the facility to ensure all information confirmed accurate during triple check process is also accurate on the claim. This will be done according to an outlined process, that could change or evolve at times, that will allow for proper documentation and will ensure that all necessary data was verified prior to billing. Additional responsibilities: + Check claim to verify correct value and occurrence codes are populated on the claim. + Check the clearing house daily for any claims rejections of claims billed in the last 30 days. Any rejections need to be worked by the validator to determine and resolve the issue to get the claim on file. + Report any trends or patterns with claim rejections or denials to revenue cycle for review. + Identify and report if a contracted payer needs to be set up for use in PCC at a contracted facility. + Ensure all managed care claims have been validated and billed out of PCC by the 10th business day after close. Any claims that are not billed out by the end of the 10th business day, require a note in PCC with an explanation for the delay in billing. + Rebilli ay corrected claims that the collections team needs submitted, due to an updated authorization, retroactive eligibility changes, diagnosis code denials, etc. + For new aquisition, pay particular detail to which NPI and Tax ID is required for specified claims for each carrier to ensure proper billing and reimbursement. + Validators are expected to be experts on managed care and able to identify appropriate lines of business, exclusions, valid authorization numbers, appropriate insurance protocols, timely filing rules, etc. + Attend, Participate, and/or Lead facility Educational In-services when appropriate. + Attend all required in-service and training programs required within your department. + Perform other related duties as assigned or requested. + Promptly reports any suspected resident financial abuse or billing fraud to supervisor immediately. QUALIFICATIONS/EXPERIENCE REQUIREMENTS + High School graduate or GED required. + Prior Work/Life experience, preferably in a long term care setting. + Prior work/life experiences, preferably in a healthcare setting. + Prior experience preferably with related software applications. KNOWLEDGE/SKILLS/ABILITIES + Knowledge of medical billing/collection practices. + Must be knowledgeable of accounts receivable practices and procedures, as well as laws, regulations and guidelines that pertain to long term care. + Must have a high degree of attention to detail. + Must have the ability to make independent decisions when circumstances warrant such action, sense of urgency. + Strong mathematical, written and verbal communication skills. + Basic computer literacy and skills + Strong organizational skills a must. About Us A family-owned company, we have grown to become one of the nation’s largest providers of post-acute care, which includes skilled nursing rehabilitation centers, long-term care centers, assisted living communities, independent rehabilitation centers, and long-term acute care hospitals (LTACH). Since 1984, we have provided superior, comprehensive management services for the development and management of adult living communities. We have a single job description at CommuniCare, "to reach out with our hearts and touch the hearts of others." Through this effort we create "Caring Communities" where staff, residents, clients, and family members care for and about one another.

CommuniCare Health Services Corporate

Managed Care Claims Validator / Biller

Sirius Computer Solutions

_Directly supporting cCare, the largest private oncology practice in California, our experienced revenue cycle management specialists simplify and optimize the practice’s revenue cycle, from prior authorization through billing and collections._. Revenue Cycle Management manages a team focused on a series of clinical and administrative processes that healthcare providers utilize to capture, bill, and collect patient service revenue.

HOUR

_What Revenue Cycle Management (RCM) contributes to Cardinal Health_ Practice Operations Management oversees the business and administrative operations of a medical practice. Revenue Cycle Management manages a team focused on a series of clinical and administrative processes that healthcare providers utilize to capture, bill, and collect patient service revenue. The revenue cycle shadows the entire patient care journey and begins with patient appointment scheduling and ends when the patient’s account balance is zero. _Directly supporting cCare, the largest private oncology practice in California, our experienced revenue cycle management specialists simplify and optimize the practice’s revenue cycle, from prior authorization through billing and collections._ The Lead – Pre-submission Billing Team is responsible for overseeing the daily operations of the billing team focused on pre-submission activities. This role ensures accurate and timely charge capture, supports denial prevention strategies, and drives performance through data analysis, team development, and process improvement. The Lead fosters a fast-paced, resolution-driven environment with a strong emphasis on communication, curiosity, and continuous learning. _Essential Functions_ + Monitor and manage daily billing workflows to ensure timely and accurate claim submission. + Organize and prioritize tasks across multiple practices, adapting to dynamic payer requirements and operational needs. + Provide guidance, coaching, and mentorship to billing staff to promote accountability and enthusiasm. + Support staff development through training, feedback, and performance monitoring. + Maintain department coverage and assist with scheduling and PTO coordination. + Analyze denial trends and AR reports using tools like Power BI to identify root causes and improvement opportunities. + Research CPT code denials against LCD/NCD requirements and payer policies. + Collaborate with cross-functional teams to implement clean claim strategies and reduce rework. + Serve as a liaison between billing staff, providers, and center leadership to resolve escalated issues. Communicate payer updates and industry changes to staff and leadership. + Participate in end-of-month closing procedures and support reporting deadlines. + Apply clinical knowledge in Oncology/Hematology, Radiation Oncology, and Urology billing. + Support documentation review and coding accuracy for complex services.Ensure adherence to standard operating procedures and compliance guidelines. _Qualifications_ + 6+ years of experience, preferred + High School Diploma, GED or technical certification in related field or equivalent experience, preferred + 4–8 years of experience in Revenue Cycle Management, preferably in a medical business office. + Bachelor’s degree in business administration, healthcare, or related field (or equivalent experience) preferred + Experience with computerized billing software and interpreting EOBs. + Familiarity with Urology, Chemotherapy, and Radiation billing. + Working knowledge of ICD-10, CPT, HCPCS coding standards. + Strong understanding of managed care contracts, Medicare, and Medicaid. + Preferred experience with GE Centricity and Power BI. + Strong organizational and analytical skills. + Excellent verbal and written communication. + Ability to manage multiple priorities in a fast-paced environment. + Customer service experience in a healthcare setting. Anticipated hourly range: $24.50 - $32.00 USD Hourly Bonus eligible: No Benefits: Cardinal Health offers a wide variety of benefits and programs to support health and well-being. + Medical, dental and vision coverage + Paid time off plan + Health savings account (HSA) + 401k savings plan + Access to wages before pay day with myFlexPay + Flexible spending accounts (FSAs) + Short- and long-term disability coverage + Work-Life resources + Paid parental leave + Healthy lifestyle programs Application window anticipated to close: 10/15/2025 *if interested in opportunity, please submit application as soon as possible. The hourly range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate’s geographical location, relevant education, experience and skills and an evaluation of internal pay equity. _Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply._ _Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal_ _Opportunity/Affirmative_ _Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law._ _To read and review this privacy notice click_ here (https://www.cardinalhealth.com/content/dam/corp/email/documents/corp/cardinal-health-online-application-privacy-policy.pdf)

Cardinal Health

Lead Coordinator, Revenue Cycle Management, Billing

Windham Professionals, Inc.

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Managed Care Claims Validator / BillerCommuniCare Health Services Corporate

Lead Coordinator, Revenue Cycle Management, BillingCardinal Health

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