General Purpose:
Ensure the timely billing of all accounts, including but not limited to: the review of registration for accurate patient demographics and insurance information, the review of bills for correct billing information and charge accuracy, the submission of timely billing, the processing of payment and explanations of benefits, responding to correspondence and telephone inquiries, contact other departments as needed, follow-up of accounts assigned by work lists or trial balance reports, resolve billing issues related to denials and rejected claims, account note entry and the filing of accounts and documents as needed to perform the above functions and in compliance with departmental guidelines. Tracks census changes and bills appropriately including Hospice. Accountable for collecting patient portion of payments and documenting accounts clearly. Maintains appropriate ledgers and sub-ledgers. Is responsible for resolving credit balances, adjustments, and write-offs after Director of PFS has approved and signed off on them.
Essential Functions
Ability to lift, walk, carry and stand. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements are represented of the knowledge, skill, disabilities to perform the essential functions.
Duties and Responsibilities
1. Utilizes rules and regulations for Long Term Care billing.
2. This position works in a cooperative team environment to provide quality customer service to internal and external customers.
3. Contact Insurance companies as it relates to authorizations and benefits in a timely manner.
4. Works closely with Utilization Review and discharge planning departments regarding any issues and follow up that may be required including authorizations and level of care changes.
5. Process billing for patient types manually and electronically (837)
6. Contact payer and or patient in accordance with the current facility collection policy.
7. Works aging reports to ensure timely clearance of accounts to meet/exceed AR aging benchmarks. Notifies Director of PFS of any accounts not paid monthly.
8. Assists all patient inquires both by phone and in person regarding monthly statements or with billing/insurance inquiries in a courteous and professional manner.
9. Maintain appropriate files and records to effectively monitor account balances to include payment plan arrangements.
10. Completes accurately documentation of all account activities in Cerner.
11. Prepare monthly cash reconciliations. Audit, investigate and resolve credit balances and or discrepancies on accounts. Initiate refund requests according to facility policy.
12. Handles and resubmits re-workable denials back to the insurance company.
13. Report to the PFS Director monthly on any accounts having issues being paid with an explanation attached.
14. Bill and follow-up on monthly resident income as appropriate.
15. Provide and assist with potential new patient new facility tours.
16. Other duties as assigned.
Skills and Abilities Required
1. Must have knowledge of Medical and Insurance terminology.
2. Must possess computer skills, office, online insurance websites, online vendor applications, and any other office equipment needed to do the job successfully.
3. Experience with Inpatient and Outpatient billing required for long term care billing.
4. Knowledge of government, non-government, commercial, third party and private pay.
5. Working knowledge of Cerner for both patient accounting system and editing applications.
6. Computer skills to process accounts appropriately and enter account notes.
7. Ability to multi-task, prioritize needs to meet required timelines.
Education and Experience Required
1. Familiar with Clinic Billing practices and reimbursement preferred.
2. High School Graduate/GED
3. One year experience of 1500 billing.
4. Analytical skills required to read, understand and identify and perform required functions.
5. Effective written and verbal communication skills.
To apply for this job please visit workforcenow.adp.com.