Senior Billing Specialist

Lutheran Senior Services•Saint Louis, MO

9d•Onsite

About The Position

Responsible for handling all complex or past-due third-party billing claims for the purpose of securing reimbursement of services (Medicare, Medicaid, Managed Care). Serves as the “myUnity” SuperUser related to their specific payer expertise. Provides oversight and coverage for 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. Investigates and codes invoices sent to us as EverTrue responsibility under Medicare SNF Consolidated Billing rules. Reviews situations referred by the Billing Specialist(s) regarding transfer of resident responsible coinsurance to private pay account after all insurance payments have been processed if the resident responsible portion doesn’t make sense in comparison to the benefits verification information. 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. Serves as a resource to residents and community billing staff for applicable insurance benefit related issues for their specific Payer expertise.

Requirements

High School diploma
3+ years of Medicare and Managed Care billing experience required
Applicable SNF/Anywhere Care Medicare and Managed Care experience required
Must possess specific payer expertise (e.g. Medicare, Medicaid, Managed Care, Anywhere Care)
Proficient computer skills including Microsoft Outlook, Excel and Word are required
Excellent communication skills

Nice To Haves

Medicare/Insurance Appeals experience preferred

Responsibilities

Resolving claims (primary and related coinsurance) transferred from the Billing Specialist for which: Payer did not pay expected reimbursement, especially if in conflict with contract terms, Claim aging is >90 days, or under 90 days and not submitted to payer and acknowledged, Claim is being audited for any reason (ADR, CERT, RAC, etc.), Claim non-payment/under-payment needs appealed or resolved
Provides oversight and coverage for 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
Serves as “myUnity” SuperUser for their specific Payer expertise to support Billing Specialist and to bring attention to Manager of Revenue Cycle Management (RCM) of any issues or enhancement ideas
Coordinates for all claim audits (ADR, CERT, RAC, National Audit, etc.) with Health Information Management Specialist (HIMS) to resolution of claim (Payment, Full Denial, Partial Denial); Coordinates information submission w/ HIMS for all appeals (including ADR appeals)
Completes monthly Allowance for Doubtful Accounts schedule for assigned payer(s)
Investigates and codes invoices sent to us as EverTrue responsibility under Medicare SNF Consolidated Billing rules
Completes applicable form to submit ll third-party payer refund requests for approval to Manager of RCM; Completes applicable form to request Accounts Receivable adjustments for approval to Manager of RCM
Reviews situations referred by the Billing Specialist(s) regarding transfer of resident responsible coinsurance to private pay account after all insurance payments have been processed if the resident responsible portion doesn’t make sense in comparison to the benefits verification information
Provides oversight and coverage for posting of ancillary charges in billing system
Month-end invoice coding for ancillary expenses related to short-stay and MCB services
Completes the Medicare Quarterly Credit Balance report for all communities
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.
Serves as a resource to residents and community billing staff for applicable insurance benefit related issues for their specific Payer expertise