Medical Billing Specialist

Description

• Submits billings to Medicare, or the appropriate commercial insurer. Ensures the accurate billing of residents, Medicare, or other third-party payers in accordance with applicable regulations and the insurer’s filing requirements.
• Follows and develops procedures to ensure compliance with the Medicare Claims Processing Manual and insurance company contracts.
• Works with insurance companies and/or provider relations representatives to file appeals, adjustments and ensure proper claims processing.
• Reviews charge data from departments that provide services to residents. Implements and maintains systems to collect and maintain accurate charge records, to be used in preparing accounts receivable billing and collections.
• Files inquires, reconsiderations, and appeals to the appropriate agencies or individuals for rejected or unpaid billings. Notifies the appropriate person within Lakeview Village when denials or requests for additional information are received.
• Works closely with Medical Records to ensure that all necessary information is available to re-file or appeal claims. Notifies the Controller when accounts remain unpaid for more than 90 days.
• Posts cash to the correct resident account, in the correct system module (e.g. IL/Resident Billing, SNF-Third-Party Billing, and Home Health Billing). Coordinates the collections process between the different areas.
• Corresponds appropriately with residents and/or responsible parties to explain statements, including, but not limited to: co-pays and co-insurance amounts as a result of third-party payments (Medicare and/or insurance).
• Submits recommendations for the forwarding of overdue accounts to a collection agency or attorney. Recommends and prepares accounts and amounts for write-off, seeking final approval from the Chief Financial Officer (CFO).
• Ensures the accuracy of the accounts receivable system with each month’s closing cycle.
• Ensures accurate coding using ICD-9, HCPCS, and CPT coding systems; files claims using the correct format required by Medicare and other insurers.
• Maintains competency by understanding and applying the changes that develop regarding Medicare Part A/b, Managed Care, and various payment strategies (i.e. PDPM, PDGM, Episodic, etc.).
• Effectively collaborates with fiscal intermediaries, accountants, auditors, cost report preparers, and private insurance companies. Prepares and provides required documentation from the accounts receivable system for annual audit and cost reports including, but not limited to: reconciliations, billing logs, and census logs.
• Develops and maintains a good working rapport with inter-department personnel, other departments within the facility, and off-campus contacts to ensure that Lakeview’s values and services can be properly maintained to meet the needs of the facility and residents.
• Ensures that Residents’ Rights to fair and equitable treatment, self-determination, individuality, privacy, property, and civil rights, including the right to express grievances are followed.
• Maintains confidentiality of sensitive information.
• Handles stress well, gets along with others in the workplace, maintains acceptable standards of conduct.
• Adheres to all safety regulations and requirements.
• Completes trainings as required by policy.
• Supportive of Lakeview Village’s vision, mission, and values.
• Performs other duties as assigned.

Qualifications

• High School Diploma or GED is required.
• At least two years of experience working in Medicare and commercial insurance billing is preferred.
• Some prior experience in skilled nursing, home health, or outpatient therapy coding or billing is preferred.
• Demonstrates good communications skills, including but not limited to effective reading, writing, speaking, and analytical skills, with a fluent understanding of English and the ability to communicate with people from diverse backgrounds.
• Demonstrates a full understanding and effective application of the Microsoft Office Suite software.
• Ability to use a computer and various software/portals to prepare bills, statements, and process billing with third parties.
• Ability to exercise independent judgement where procedures cannot be standardized.
• Possesses an empathetic approach to the elderly.
• Able to work in a team setting with residents, relatives, staff, and others.
• This position in on-site only with no ability to work from home.