This position will be responsible for billing and business office functions for assigned Neighborhood(s) and/or LifeStyle Communities (SNF, AL, IL). This position reports directly to the Director of Accounts Receivable.
- Maintain current knowledge of industry compliance including new regulations, conditions / requirement of participation, and third part insurance billing requirements.
- Preform all aspects of billing for all payers including but not limited to electronic billing and claims follow up/resolution, Private Pay statements, collection letters, insurance verifications, 9401 & Change Form communication through Provider Gateway, and communication with Council on Aging and respective County agencies.
- Train and support Neighborhood(s) and/or LifeStyle Community partners on basic business office and billing functions, so they can assist with their respective assigned duties regarding patient accounts and billing.
- Assist with communication and data collection between Medicaid Billing Specialist, Medicaid Caseworker, Social Worker, Elder and Families as needed.
- Run monthly MITS checks for all elders to identify changes in case coverage, enrollment in Managed Care plans, Liability, LTC Facility Placement, Restricted Coverage Periods, and status of Waiver or Nursing Home benefit assignment. Take all appropriate action(s) on accounts to update, adjust claims, and notify partners.
- Maintain accurate and up to date daily census in Point Click Care in a timely manner. Validate and check all daily census activity, and update Payer Trees as required in accordance with member coverage and billing standards.
- Coordinate and report on monthly Managed Care census to verify elders, days, levels, authorizations, and other case specific data as required.
- Process monthly LTC statements by the 5th of each month (for prior month's activity / confinement) on accounts for which policy information has been provided to assist elders in obtaining all benefits they are eligible to receive.
- Make any necessary retroactive census changes, process adjustments as required, and coordinate / communicate regarding impacts on prior period revenue recognition.
- Collaborate with clinical staff for the completion of MDS Assessments, and collaborate with therapy department as related to pre-billing checks (Triple check, UB Watch / CareWatch, Etc.)
- Assist with month end close procedures including by not limited to cash reconciliation, ancillary uploads, bill payer setup screens for claim coding (prior to claim submissions monthly), coordinate with external vendors for billing data, and assist with reporting as requested.
- Posting of Cash Receipts on a daily basis to maintain current up to date AR balances, and process necessary adjustments concurrent with Cash posting and Zero balance or Zero paid remittances.
- Monthly review of Accounts Receivable Aging reports, and follow up on past due balances through to completion and appropriate payment processing.
- Communicate with Neighborhood(s) and/or LifeStyle Communities partners and/or families regarding receivable balances in a clear, respectful, customer service oriented manner.
- Investigate credit balances monthly, and process refunds and adjustment as needed in accordance with department procedures reviewing all open AR balances.
- Maintain customer confidentiality in accordance with all HIPPA regulations.
- Support the Mission and high standards of customer service as it pertains to both internal customers, external customers, and partners of Otterbein Senior Life.
- Crosstrain with other positions within the department to provide coverage, support, and understanding overall functions of the department.
- Maintain daily documentation in PCC Collections on payer and period balances and other relevant account information. Note all adjustments, account updates, and pertinent contact to support accurate and up to date account notes.
- Other duties as assigned.
- Strong Communication skills (verbal and written) to communicate with coworkers, families and outside vendors in remote locations to obtain needed information and provide support to effectively prepare accounts for the billing process and resolve billing issues.
- Above average understanding of full billing process from point of care to payment collection.
- Strong critical thinking / decision-making skills to make informed decisions on how to proceed with billing concerns and issues.
- Positive customer service attitude towards others by taking ownership in problem solving and taking initiative to research and resolve billing issues.
- Ability to communicate positively, effectively, and appropriately with elders, families, leadership, clinical staff, and other partners.
- Ability to understand and explain complex Accounts Receivable and Revenue Cycle questions.
- Ability to manage multiple priorities to meet the needs of our customers, and achieve department timelines and goals.
- Ability to work independently without supervision.
- Detail oriented especially to identify and resolve billing discrepancies and/or questions.
- Education – Associate's Degree in Accounting, Business Administration, or equivalent experience is required.
- Length of Experience – Minimum 5 years long-term care billing experience required and knowledge of Medicare, Medicaid, Managed Care, Private Pay, MyCare Ohio, Supplement plans, Waiver, Resident Trust, and other payers in the SNF and Assisted Living environment.
- Prior experience as a Business Office Manager in a skilled nursing facility preferred. Supervisory and training experience of business office and billing process preferred.
- Experience working with computerized account systems, Microsoft Excel, and Point Click Care or other similar billing software.
Apply on company website