Self Directed Billing Specialist

Have you been searching for a career that is meaningful, where you could make a positive difference to others? Have you been seeking a career that gives you a sense of purpose where you can contribute to people's well-being? Do you enjoy helping others succeed? If yes, we have an opportunity for you

Our person-centered approach allows you to help make a positive impact in people's lives. Apply today and begin your career by making a difference and fulfilling your sense of purpose

We are seeking an attentive and compassionate team member to join our team We offer a generous benefits package to include options for medical, dental, vision, employer paid life insurance, 403 b with employer contribution, PTO accruals, paid training, and more
Make any day a payday You work hard for your money, why wait to be paid
Job Summary
The Self Direction Billing Specialist is responsible for ensuring timely, accurate, and compliant billing for services delivered under the Office for People with Developmental Disabilities (OPWDD) Self Direction program. This position requires proficiency with EVero software to manage billing processes, track utilization, reconcile records, and ensure all billing is submitted to accounting on a monthly basis. The Billing Specialist plays a key role in maintaining fiscal accountability and supporting the financial sustainability of the Self Direction program.

Job Functions
Regulatory and Corporate Compliance

• Ensure all billing practices adhere to OPWDD regulations, Medicaid guidelines, and internal Corporate Compliance standards.
• Verify that services billed fall within approved Life Plan, Approved Budgets, and OPWDD service authorizations in eVero.
• Maintain an accurate audit trail of all corrections, resubmissions, and billing-related communications.
• Assist with internal and external audits by preparing and submitting required documentation and reports.
• Maintain current knowledge of OPWDD Self Direction policies, eVero system updates, and Medicaid billing requirements.

Financial Management

• Review, prepare, and submit Self Direction billing claims through eVero on a monthly basis.
• Cross-check units utilized against authorized budgets to confirm services do not exceed participant allocations.
• Reconcile denied or rejected claims, correct errors, and resubmit promptly to ensure timely payment.
• Run eVero reports to identify unbilled services and ensure submission before monthly deadlines.
• Provide monthly utilization and billing summary reports to program leadership and Accounting.
• Complete submission of invoices for payment through eVero every Monday, Wednesday, and Friday.
• Complete Payroll submission to Finance every Monday, Wednesday, and Friday.
• Complete Paid Neighbor payment submissions to Finance every Friday.
• Follow up with SDS team for any errors, incomplete Billing, or missed Deadlines.

Person Centeredness Responsibilities

• Support accurate billing that ensures participants' individual budgets are used appropriately and as intended.
• Work collaboratively with Self Direction Coordinators and Brokers to resolve documentation or budget discrepancies that may impact participants' services.

Program Standards

• Conduct exception reporting in eVero to identify duplicate claims, overlapping hours, or missing documentation.
• Validate service codes and reimbursement rates to ensure alignment with OPWDD-approved standards.
• Audit staff time and attendance records against scheduled and authorized hours; ensure EVV (Electronic Visit Verification) compliance when required.

Physical Plant and Safety

• Maintain a safe, distraction-free, and ergonomically appropriate home office environment that supports effective job performance.
• Ensure secure storage of sensitive information in compliance with HIPAA, OPWDD, and agency confidentiality requirements.
• Use agency-approved equipment (laptop, monitors, etc.) in accordance with IT and safety guidelines.
• Promptly report any safety concerns, equipment issues, or work-related injuries that occur in the home office setting.
• Follow organizational policies regarding cybersecurity and remote access to protect agency data and participant information.

Contact With Others

• Collaborate with Self Direction Coordinators, Brokers, and Accounting staff to ensure billing accuracy.
• Communicate proactively with staff to resolve service documentation issues prior to billing deadlines.
• Work with external auditors or regulatory reviewers as needed during compliance checks.

Additional Functions

• Assist in identifying and recommending process improvements to reduce recurring claim issues or denials.
• Provide backup support to the billing or finance team during absences or peak periods.
• Trainer for New Hire Orientation
• The Billing Specialist is expected to keep their camera on during all virtual sessions.

Required
Required Qualifications

• Associate's degree in Accounting, Business Administration, Health Information, or related field (or equivalent work experience).
• Minimum of 2 years of billing or finance experience, preferably in OPWDD or healthcare-related services.
• Strong proficiency with EVero software, including service authorizations, claim submissions, and reporting.
• Knowledge of Medicaid billing regulations and OPWDD Self Direction program requirements.
• Strong attention to detail and organizational skills.
• Ability to manage multiple priorities and meet strict deadlines.
• Accuracy and attention to detail.
• Strong problem-solving and analytical skills.
• Ability to have clear and professional communication
• Proficiency in Microsoft Office Suite (Excel, Word, Outlook).

Preferred
Experience with Electronic Visit Verification (EVV) systems.

Prior experience in a nonprofit or human services setting.

Accountability and reliability in meeting monthly billing deadlines.

Authority And Accountability
People:
This position has no supervision requirements

Operations:
This position is responsible for managing all aspects of the Self Direction billing process

Budget:
This position is responsible for ensuring billing aligns with approved participant budgets, monitoring utilization, and reconciling claims to prevent over- or under-spending.

Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.