Insurance Utilization Review Jobs in Connecticut

Come grow with us! Are you ready to work for a company that is uniquely different; an organization that is committed to your personal and professional growth? Then come join the team at Apple Rehab Mystic, one of Connecticut’s leading providers of short term rehabilitation and skilled nursing care.

Apple Rehab is a family owned and operated company that treats residents and staff like family too. Our expert team of senior management is located at our home office, right in Avon, CT, ensuring superior care from a local company. Our leadership is not across the country, but rather in your backyard.

Job Description:

40 hours/ week

ACCOUNTS RECEIVABLE BUSINESS OFFICE MANAGER

Reports To: Facility Administrator

Staff Supervised: As designated by Administrator

General Purpose:

Accounts Receivable Business Office Manager plans, organizes, develops and implements all accounts receivable functions in accordance with current company policies as well as federal, state and local regulations and procedures in an accurate, neat and organized manner while ensuring that the highest quality of service is provided.

Qualifications:

• Completion of secondary education showing the ability to read, perform mathematical calculations, write in a legible manner and follow oral and written directions in English.
• Accounts Receivable Business Office Manager is experienced in Point Click Care or other EHR and Billing systems, RFMS or other Resident Trust systems, and electronic claims management systems.
• Attention to detail, good follow through skills and ability to prioritize multiple tasks.
• Must be innovative and able to find creative ways to service the variety of residents’ needs and maintain the customer focus.
• 3-5 years experience in long-term care billing and collections; working knowledge of State Medicaid and Medicare law and third party insurance.
• Patience, tact and a positive attitude toward residents, family members, state and federal agencies and other staff.
• Demonstrates cooperation in assisting others and ability to work as a team.

Essential Job Functions (With or Without Reasonable Accommodation):

Leadership Functions:

• Participates in Department Head meetings and activities
• Leads by example and addresses all observed areas of concern or concerns brought by others
• Communicates and collaborates with all departments, receiving criticism and ideas for improvement in a positive way
• Participates and encourages a culture of compassion, caring, mutual respect, and outstanding customer service.
• Builds relationships with staff, residents, family member, vendors, and consultants to ensure customer and staff satisfaction
• Motivates all staff members by effective listening and positive feedback whenever possible
• Maintains an approach of continuous improvement (Quality Assurance/Performance Improvement), with resident care as the primary focus

Administrative Functions:

• Reviews all new admission payers for eligibility; advises pre-admission of payer concerns as needed; coordinates with the care team as well as Resident/family members to plan for coverage in advance of payer change; oversees the Medicaid application process to ensure responsible party is providing timely information to the LTC unit at DSS office
• Maintains accurate daily census including all residents and their payors. Reports census to all departments on a daily basis. Participates in all facility meetings related to billing and potential payor changes, which may include morning report, Medicare/Utilization Review, PPS, etc
• Communicate all information related to payor changes to the appropriate departments, including nursing, therapy, MDS, and Social Service as it pertains to resident services
• Monitor and oversee Medicaid renewal applications with responsible party to ensure continual coverage and necessary spendown is done timely
• Organizes prepares, and submits all billings accurately and by deadlines
• Monitors accounts receivable aging reports ongoing throughout the month and follows through on past due accounts, ensuring all appropriate action is taken to avoid bad debt
• Utilize corporate mandatory action steps for collection on past accounts (i.e. phone call, legal letter, etc)
• Make notes in software system on past due accounts indicating action taken
• Communicates all concerns related to payment timely to the Administrator as well as legal counsel and Corporate VP of AR as needed
• Open and process mail received daily
• All cash receipts (including cash, checks, EFT and credit card payments, etc) must be deposited and posted on a daily basis
• Track and monitor all Medicare ADRs and CMA Appeal Requests to ensure timely submission to the Corporate Clinical Reimbursement Director
• Prepares and mails resident account statements quarterly and as needed or at the resident or responsible parties’ request
• Plans for the preparation, review and submission of financial reports and audits to all appropriate regulatory agencies , Administrator, and to appropriate corporate staff

• Manage the Resident’s Trust Accounts to ensure Resident’s allowance and appropriate level of petty cash is available; Applied Income is paid to facility timely; bank accounts are reconciled to ledgers monthly; T19 resource limits are maintained; Resident accounts are not overdrawn at any time.

• Maintains resident confidentiality and privacy. Knows and complies with the Residents’ Bill of Rights.

Apple Rehab offers an attractive benefit package for employees of 30 hours or greater that may include the following:

• Scholarships and career growth opportunities
• 4 Weeks Paid Time Off
• 7 Paid Holidays
• Health Insurance Benefits
• Short Term & Long Term Disability
• Call-a-Doc / 24-7 MD telephone service
• Employee Assistance Program
• Life Insurance
• 401K Retirement Program
• Longevity Credit