ESSENTIAL DUTIES AND RESPONSIBILITIES Serves as a subject matter expert with regards to all aspects of skilled nursing billing processes and the respective biller roles. Maintaining an advanced knowledge of payor updates including Federal and State guidelines, department workflows and resources needed to resolve payor rejections, billing errors and troubleshoot identified denial trends to ensure clean claim rate. Knowledgeable with billing software MatrixCare and Epic crossed trained in multiple billing sectors (Medicare, Medicaid and Commercial ) to assist in the Epic biller work queues as needed. Knowledge of verifying payor sources Knowledge of state and federal nursing home guidelines Track facility census information, send census on daily basis Complete census, payer builds and payer verification in MatrixCare. Review resident accounts and aging reports on ongoing basis. Responsible for monthly Medicaid, Medicare, and other insurance billings along with timely follow-up with intermediaries on delinquent payments in coordination with outside billing company Monitor and manage the accounts receivable collection process Pursue past due accounts persistently and maintain proper back-up documentation. Obtain and submit all required documentation to bill third party payers as per program/company guidelines. Participate in the resident admission process by providing explanations of the facility's rates, billing cycle and payment terms, including collecting the first month's advance payment upon admission. Perform all Month End duties to ensure revenue is booked and billed correctly and timely. Maintains personnel and resident files in accordance with all applicable laws and regulations. Develops and implements policies and procedures related to Skilled Nursing Facility patient access. Implement procedures related to our financial services policy and ensure proper workflows to meet revenue and reimbursement goals. Maintain the skilled nursing facility billing program including charge master updates, fee schedule maintenance, user account maintenance, and census event registration maintenance. Complete and process audit requests and follow up to ensure that payers receive information needed and that reimbursement is not affected. Supervises business office staff. Conduct employee Performance Reviews with subsequent discussion of pertinent review findings and recommendations. Hires partners for Skilled Nursing Facility patient financial counseling, provide training, coaching and disciplining employees; and resolve employee issues. Provide a primary point of contact for customer inquiries and work with patients and other customers face to face or by phone. Providing excellent customer service and ensure that employees provide the same positive and helpful image. Uses problem solving skills to identify and correct problems before they escalate to larger issues. Collaborate and communicate with other departments to ensure positive interdepartmental interactions. Assist with the follow up on patient billing complaints received. . Maintains professional and technical knowledge by attending educational workshops; review professional publications; establish personal networks and participate in professional societies. CULTURE OF EXCELLENCE BEHAVIOR EXPECTATIONS To perform the job successfully, an individual should demonstrate the following behavior expectations: Quality - Follows policies and procedures; adapts to and manages changes in the environment; Demonstrates accuracy and thoroughness giving attention to details; Looks for ways to improve and promote quality; Applies feedback to improve performance; Manages time and prioritizes effectively to achieve organizational goals. Service - Responds promptly to requests for service and assistance; Follows the Mercyhealth Critical Moments of service; Meets commitments; Abides by MH confidentiality and security agreement; Shows respect and sensitivity for cultural differences; and effectively communicates information to partners; Thinks system wide regarding processes and functions. Partnering - Shows commitment to the Mission of Mercyhealth and Culture of Excellence through all words and actions; Exhibits objectivity and openness to other's views; Demonstrates a high level of participation and engagement in day-to-day work; Gives and welcomes feedback; Generates suggestions for improving work: Embraces teamwork, supports and encourages positive change while giving value to individuals. Cost - Conserves organization resources; Understands fiscal responsibility; Works within approved budget; Develops and implements cost saving measures; contributes to profits and revenue.
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Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree