Position Summary: Responsible for enterprise-level patient/resident billing that expands to Assisted Living and Skilled Nursing (Healthcare) divisions. Inclusive of primary medical billing, secondary medical billing, and all ancillary patient / resident expense items.

Supervise accounts receivable, accounts payable, and billing functions and monitor the status of same.

Supervisory:

• Business Services Representative & Accounts Payable Administrator

Essential Duties:

• Responsible for enterprise-level patient/resident billing that expands to Assisted Living and Skilled Nursing (Healthcare) divisions. Inclusive of primary medical billing, secondary medical billing, and all ancillary patient / resident expense items.
• Performs Daily Census Reconciliation.
• Responsible for preparing Medicare Part A, Medicare Part B, Third Party Insurance, Medicaid, and Private Pay billing. Responsible for organizing Medicare appeals and all correspondence for Medicare and insurance issues.
• Creates and implement policies and procedures for all aspects of patient/resident billing.
• Stays abreast of changes in legislation and updates to laws and compliance regulations of Medicaid and Medicare.
• Ensures recertification of insurance contracts which will include Medicare Recertification.
• Creates and manages all Medicaid applications, including,
• The startup process -contacting the resident’s family, discussing the process, and obtaining all requirement documentation.
• Keeping track of application completion and assisting families with the application process
• Following up with the Medicaid representative on the application status
• Submitting additional information to Maryland Medicaid as requested.
• Submitting a redetermination, annually, on all Medicaid residents.
• Audits claims for completeness and accuracy prior to submitting to ensure clean claims.
• Performs collection calls to resident’s representative for residents’ private resources due.
• Accurately transmits electronically claims for Medicaid and Medicare billing each month in a timely manner.
• Maintains Medicaid and Medicare Logs and other Cost Reports related schedules including preparation of Credit Balance Reports.
• Creates and submits coinsurance claims with EOBs attached once Medicaid and Medicare payments arrive. Maintains Medicaid co-insurance write-off log (65/35).
• Immediately notifies CFO and Administrator of audits, Office of Attorney General Notifications, Medical, or Legal authorities which includes IRS and any other regulatory or legal agency.
• Ensures all returned claims are reviewed and corrected on a daily basis.
• Recognize problem accounts and notify Controller/CFO to assist in problem-solving.
• Monitors Accounts Receivable for unpaid claims and follows up with phone calls, contacting insurance companies to work through denials, etc. in accordance with collection policies.
• Generates total billing figures and balances to the census.
• Prepares monthly explanations of accounts over 30 days past due for Controller/CFO. Takes appropriate action to collect all monies owed to St. Mary’s Nursing Center, and keeps Controller/CFO informed of any collection problems.
• Maintains the strictest confidentiality; adheres to all HIPAA guidelines and regulations,
• Attends and participates in continuing educational programs.
• Attends committee meetings as requested.
• Consistently displays professionalism and promptness in dealing with residents, responsible parties, other departments, and regulatory entities when resolving billing issues.
• Performs other duties as assigned by the Controller / CFO.

Key Competencies:

• Advanced knowledge of the laws, regulations and guidelines that pertain to Long-Term Care and Medicare billing guidelines and Medicaid Billing Guidelines.
• Knowledge of accounts receivable billing and collections computer programs.
• Knowledge of the principles, practices, and regulations of long-term care.
• Must have the ability to understand and interpret policies and procedures.
• Ability to establish and maintain effective working relationships with residents, responsible parties, coworkers, insurance companies, and government agencies/personnel.
• Advanced knowledge of Microsoft Office Suite, Outlook, and researching utilizing the internet.
• Must be capable of handling complex situations with residents and family members.
• Must be able to maintain the highest level of confidentiality regarding resident-related information.
• Must be able to meet the standards of the St. Mary’s Nursing Center.

Minimum Qualifications:

A high school diploma or equivalent is required. Must have a minimum of five years of medical billing experience preferably in a healthcare environment and long-term care.

Work Environment:

• Must be able to sit for extended periods of time throughout the work day.
• Must be able to relate to and work with ill, disabled, elderly, emotionally upset, and, at times hostile individuals within the facility.
• Must be able to lift, push, pull and move a minimum of thirty (30) pounds.
• Must be able to assist in the evacuation of residents.
• Sits stands, bends, lifts and moves intermittently during working hours.
• Works beyond normal working hours as needed.