Billing Specialist

Lutheran Senior Services•Saint Louis, MO

17d

About The Position

Summary Responsible for handling initial third-party payer billing (Medicare and managed care) for the purpose of reimbursement of services, cash receipts posting and other month-end charge entry duties; Upholds the philosophy, core values and goals of the organization and ensures that the Christian Mission of EverTrue is realized – “ Older Adults Living Life to the Fullest ”.

Requirements

High School diploma
1 – 3 years of Medicare billing experience
Proficient computer skills including Microsoft Outlook, Excel and Word are required

Responsibilities

Initial billing of skilled nursing facility/Anywhere Care claims to third party payers (Medicare, Managed Care, Commercial Insurance) or vendor Medicaid claims (Medicaid, Managed Care Medicaid and Medicaid Hospice) for multiple EverTrue sites, utilizing electronic claims submission
Ensures claims are received, and if returned to provider, resubmitted in a timely manner
Bills coinsurance claims where the primary insurance pays without issue; Refers more complex or past-due claims to the Senior Billing Specialist as needed
Posts cash receipts to Accounts Receivable (A/R) for third-party payer payments
May be responsible for filing of Medicare no-pay, benefit exhaust and information claims
Responsible for transferring claims to Senior Billing Specialist if: Primary payer does not pay expected reimbursement, especially if in conflict with contract terms. Claim aging becomes >90 days, or under 90 days and not submitted to payer and acknowledged Claim is being audited/reviewed for any reason (ADR, CERT, RAC) Claim non-payment/under-payment needs to be appealed
Maintains up-to-date technical knowledge of applicable Medicare/Medicaid/Managed Care/Anywhere Care billing rules and regulations via the CMS website, MAC website, etc.
Inputs Medicare ancillary charges in billing system in a timely manner
Serves as a resource to residents and community billing staff for applicable insurance benefit related issues
Serves as backup to RCM Billing Specialist; Handles verification of resident’s Medicare/Medicare Managed Care/Medicaid/Commercial Insurance benefits prior to receipt of third-party billable services
May handle small balance adjustments of $10 or less
May be responsible for maintaining Medicare Coinsurance bad debt schedule for cost report
Handles maintenance of resident income related to retroactive vendor Medicaid authorizations or retroactive changes in resident income
Handles Medicaid re-billing of charges related to retroactive vendor Medicaid authorizations or retroactive changes in resident income