Billing Rep - Long Term Care - FT
Responsible for accurate and timely billing and account collection.
Obtains required billing information / documentation (pre-certifications, codes, insurance information) and enters into database.
Identifies and resolves denied claims, escalating accounts as necessary to ensure timely payment of claims.
Assists customers with billing questions.
Prepares and maintains billing and related reports.
• Identifies items to be billed by procedure and services performed; obtains necessary documentation for billing; obtains pre-certifications; enters all charges and submits bills in accordance with policy.
• Posts payments, performs daily reconciliations, produces daily census, prepare refunds and performs month end close. Maintains data in billing management system, i.e. updating current and adding new demographic information, and ensures that documentation entered is accurate and complete.
• Manage PNA accounts – Record daily withdraws and deposits, reconcile bank statements, PNA accounting (SS) process month end reports for finance. (LTC only).
• Financial Meetings- Meet with family/resident regarding financial status for LTC services. (LTC only)
• Medicaid Pending Accounts- Track and monitor accounts with family/resident and outside agencies. Update billing system according to approvals and denials. Escalating accounts to manger/administration as necessary. (LTC only)
• Attend Utilization Review (UR) meetings weekly – communicates with various departments to ensure accuracy of resident payer status, discharge plans and transactions to LTC. (LTC only)
• Coordinate charges for outside services – Verify and identify charges for proper billing according to contracts and Consolidate Billing (LTC only)
• Completes forms for residents eligibility - Rep Payee, direct deposit for residents income for Social Security and Pension, change of address, redeterminations (LTC only)
• Private Legal Collections- Prepare collection accounts for legal, collections letters, payment arrangements, phone calls (LTC only)
• Analyzes, identifies and trends billing issues to proactively reduce denials and variances. Works system generated reports such as residual balance, credits, no-pay. Reports and resolves variances and inefficiencies, escalating accounts as necessary to resolve billing issues.
• Assign ICD9 codes based on review of documentation and ensure proper charges are assigned (MICU only).
• Interacts / communicates effectively with various department staff and assists customer service inquires both internally and externally: liaison with Patient Accounting and Physician billing services, employers and insurance carries to ensure accurate and timely billing process; maintains open communication with management regarding billing and coding issues including documentation, denials/appeals, etc. Follows up on assigned insurances on a monthly basis and maintains records of declined claims requiring appeals.
• Reviews of all patient records for compliance with CMS requirements for signatures on AOB’s, etc. (MICU only)
Position Qualifications Required / Experience Required:
1-3 years experience in billing, collections, registration, or related hospital / office environment.
Must have fast, accurate data entry skills.
Good organizational skills and attention to details.
Must be able to work in a fast paced environment with excellent customer service and interpersonal skills.
PC literate with a working knowledge of Microsoft Office applications (Word, Excel, Access).
Experience with EMS specific coding preferred (MICU only).
High School diploma or equivalent.
CHAA preferred (MICU only).
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