POSITION SUMMARY: Resolve issues regarding payment for claims/bills denied for all reasons other than Medical Review. Perform follow-up activities to assure Medicaid and Medicare insurance payments are received. DSO/DSO Target Ratio Timely filing of Medicaid/Medicare claims/bills
Facilitate non-Medical Appeals and Timely Filing Appeals.
May perform position of Specialist in order to meet team deadlines. (See Specialist, Billing job description)
RESPONSIBILITIES/ACCOUNTABILITIES: Prepare Claim Submission: * Perform pre-bill analysis. * Analyze Bill Edit and Exception Report. * Liaise with SNF Customer Service Staff to resolve billing issues; issue/resolve BUGs. * Make hardcopy corrections and update billing system. * Print and File UB92 and Edit Reports per department standard. Edit Claim Submission: * Review and process corrections for claims on hold in FI Systems * Resolve errors/omits/adjustments on FI Systems. * Process non-census adjustments/corrections in billing system. Resolve Claim Denials (excluding Medical Review) * Review Denials and if Medical Denial, notify Reimbursement Department. * Contact payor regarding claims issues, problems or failure to pay. * Influence Payor Representative to review claims during call and communicate status. * Submit supplemental information if required. * Re-submit claims/bills in response to billing errors. * Process non-Medical Appeals and Timely Filing Appeals to resolution. * Monitor Claims Resolution status with Reimbursement Department * May initiate Write Off Document if required.
Other * Resource to Specialist in reconciling claims. * Train or retrain staff members. * Assist Supervisor or Team Leader with special projects. * Monitor aging. * Demonstrates care and compassion to ensure that all internal and external customers consistently receive the highest quality of service. * Shows respect and appreciation to others. * Works with a positive attitude, demonstrating teamwork and enjoyment for the job. * Demonstrates focus and discipline to in doing the best job possible. * Exhibits honesty and integrity in all aspects of the job. * Performs other duties as requested.
Qualifications: SPECIFIC EDUCATIONAL/VOCATIONAL REQUIREMENTS: 1. Associate's Degree or 5 or more years in healthcare or long-term care billing and collections. Specialty in Medicare, Medicaid billing. 2. Experience with healthcare billing software 3. Enjoys working in high volume environment. JOB SKILLS: Leadership: Foster positive working relationships with Center Staff to achieve organizational goals. Perceived as expert in area of specialty. Act as Resource for others on Team. Financial Management: Expert in Medicare, Medicaid and/or Insurance Benefit Plans, benefit coordination, payor requirements on submitting claims, and techniques in how to submit a clean claim to ensure payment at first pass. Expert in processing claims in multiple systems. Thorough understanding of the unique requirements of different billing systems. Expert in identifying factors affecting DSO and Bad Debt e.g. Payor Source Sequencing, Coordination of Benefits, Insurance Requirements, Asset Spend Down, Grant Approval, Appeals/Denials. Business Skills: Demonstrate expert level administrative and organizational skills. Document in writing all actions relating to a specific case. Assure all records are up-to-date and reflect current activity on a daily basis.
Requisition Number: 418687
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