Patient Services Representative

Catholic Health Services•Lauderdale Lakes, FL

7d•Onsite

About The Position

Responsible for the billing and timely follow up of all assigned Medicaid claims for Nursing Home and Hospital in a cost-effective and efficient manner. Successful accounts receivable management is predicated on working closely with nursing home and hospital business office and admissions staff, as well as the various governmental regulatory agencies (i.e., DCF).

Requirements

High school diploma and two years related experience of a combination of education and training.
Must be knowledgeable with computers, calculators, system applications, spreadsheets and other related office equipment.
Must have knowledge of computer office/clinical software
Must be able to read, write and understand the English language

Responsibilities

Billing of all Medicaid claims via the SSI software (and when appropriate web portal or paper billing). This includes editing billing data, and reconciling all bills via KNS.
Follow up on all outstanding claims greater than 30 days. This includes the successful resolution of all claims in a timely and cost-effective manner.
Run all A/R aging reports after KNS month end to use as an A/R management tool.
Complete A/R spreadsheets and be prepared to review details with management at scheduled monthly review meetings.
On going management of detailed A/R trial balance for Medicaid/Medicaid MMC/MMA payers to ensure proper timeliness of billing claims, appropriate documentation (i.e., authorizations, NOCA’s, etc.) are received and included on claims, appeals are submitted within appropriate timeframe. This includes the overall compliance with all Medicaid (State) regulatory guidelines.
Follow up and facilitate resolution of all denied claims. Including identifying and communicating to Director root causes and trends resulting in denials (CBO; Facility; etc.)
Obtains Medical Records from appropriate facilities for the purpose of appealing denied claims.
Ensure that most recent NOCA’s are updated in the KNS database and maintained for future audits.
Maintain close working relationship with facility counterparts in business office, admissions office, case management office, medical records office, etc. to ensure effective revenue cycle management.
Utilization of all departmental system tools (i.e., KNS; Trace; SSI; etc.).
Identify and communicate any and all systemic issues that may result in payment delays, underpayments, lost revenue, etc.
Billing and follow-up for Medicare co-insurance billing to Medicaid and/or Medicaid MMC/MMA payers for SNF and all other lines of business (i.e., Hospital; Outpatient and Clinics).
All other duties as assigned by the Revenue Cycle Manager.
Maintain your required license, certifications and mandatory skill updates.
Comply with all policies, local, state and federal laws and regulations.
Perform other duties as assigned.